Community-dwelling Stroke Survivors Research Articles

Feeling lonely and dissatisfied – understanding social network functioning in stroke survivors

BackgroundPost-stroke social networks are associated with functional recovery. However, there is little information on the social networks of stroke survivors and whether institutionalised and community-dwelling stroke survivors view their social relationships differently.PurposeTo i) examine social networks of stroke survivors and any influencing sociodemographic factors, as well as to ii) compare differences between institutionalised and community-dwelling stroke survivors.MethodsStroke survivors were recruited from eight healthcare institutions in Singapore. Stroke Social Network Scale (SSNS) was administered to assess the social network functioning. Multidimensional State Boredom Scale (MSBS) was used to evaluate state boredom levels.Results160 stroke survivors completed the study. Stroke survivors reported a mean (SD) of 53.7(17.2) on the SSNS total score. Institutionalised stroke survivors reported significantly lower SSNS scores than community-dwelling stroke survivors, (U = 1856.5, z=-4.234, p < .001). Nearly a third (30.6%, n = 49) of the stroke survivors reported feeling lonely. Only 28.1% (n = 45) stroke survivors reported being ‘Very Satisfied’ with their overall social network. Compared to community-dwelling stroke survivors, institutionalised stroke survivors felt more lonely (40.7%) and only 25% were very satisfied with their social network with all p < .05. A moderate correlation was found between SSNS ‘Satisfaction’ subdomain score and MSBS total score, r=-.401, p < .001.ConclusionsStroke survivors had poor functioning social relationships. This study found that the perceived social support of institutionalised stroke survivors was poorer than community dwelling stroke survivors. A large proportion of stroke survivors reported feeling lonely and were not satisfied with their social networks. Identifying those at risk may be a means to prevent loneliness, increase social network satisfaction to improve well-being and quality of life.

Level of disability in stroke survivors in the greater accra region of ghana: a cross-sectional study

Abstract Background Many stroke survivors in low- and middle-income countries such as Ghana live with various degrees of disabilities. Insight into the level of disability and its determinants in stroke survivors has become very important. This study aimed to assess disability and determinants in stroke survivors in the Greater Accra Region of Ghana. Methods One hundred and eight community-dwelling stroke survivors undergoing outpatient physiotherapy rehabilitation were sampled for the study. The World Health Organization disability assessment schedule (WHODAS) questionnaire was used to assess the level of disability in the participants. Sociodemographic and clinical data were gathered to help assess the determinants of disability. Association between sociodemographics and disability, and clinical characteristics and disability were determined using chi-square/Fisher’s exact test. p values less than 0.005 were considered statistically significant. Results Most of the study participants were reported to have moderate to severe disabilities in their bodily function. Age, gender, marital status, and employment status were found to be associated with the level of disability in stroke survivors. Conclusion Disability and its determinants in stroke need to be given much attention as disability affects the ability of stroke survivors to function independently.

Do facilitators and barriers to community ambulation differ among stroke survivors in low resource settings? A cross-sectional study in Nigeria

ABSTRACT Purpose Stroke survivors (SSV) in many low- and middle-income countries experience frustrating participation restriction in community ambulation (CA), which impedes community life. This study assessed facilitators and barriers to CA among community-dwelling SSV in a southwest state of Nigeria. Methods This cross-sectional study involved 66 community-dwelling ambulating SSV, purposively recruited from physiotherapy out-patient clinics of selected hospitals in southwest Nigeria. Semi-structured questionnaire containing physical and social environment elements of the ICF domains was administered on respondents. Mobility status at home and community, socio-demographic and clinical data of SSV were also obtained. Responses from open-ended questions were triangulated with appropriate close ended options. Data were analyzed using descriptive statistics and logistic regression at p < 0.05 Alpha value. Results Majority of the SSV were independent in their homes (59.1%), used mobility aids (87.9%) and assisted in CA (66.7%). They identified limited physical accessibility by crowds 25 (37.9%), lack of inclined surfaces 40 (95.2%), uneven floors 36 (87.8%), public seating arrangements 33 (78.6%), rain (73.8%) and inability to use services, systems and policies (77.3%) as barriers to CA. Built physical environment was a significant predictor of home (OR = 0.754, p = 0.001) and community mobility (OR = 0.850; p = 0.018), while post-stroke depression was a significant predictor of community mobility (OR = 1.038; p = 0.014). Conclusion Mobility aids, social attitudes and general support were identified as facilitators, whereas barriers to CA included built physical environment, services and policies, products and technology. Facilitators and barriers to CA are similar to some HIC contexts, perceived difficulties and experiences differ for infrastructural and social reasons among others.

Prevalence of poststroke fatigue and its relationship with clinical characteristics among community-dwelling stroke survivors: A cross-sectional survey

Background and objectivePoststroke fatigue is widely overlooked due to a lack of awareness, definite cause, and cure. It is influenced by cultural variance in psychosocial factors and stroke epidemiology patterns across different countries. To date, the prevalence of poststroke fatigue has not been determined in the Indian setting. Hence our objective was to estimate the prevalence of fatigue among community-living late subacute and chronic stroke survivors. Additionally, we determined the association between poststroke fatigue and participants’ clinical and demographic data. MethodsA cross-sectional survey was conducted among first-time stroke survivors following discharge from two tertiary care hospitals. Medical records were screened and included if they met the criteria for age >18 years, able to follow a two-step command with no existing neurological or systemic conditions that would influence fatigue scores. Telephonic consent was obtained, and an interview was conducted to obtain the scores for fatigue, daytime sleepiness, depression, functional mobility, and disability. ResultsA total of 323 participants (mean age: 60.3 ± 12.6 years, mean stroke duration: 8.6 ± 4.4 months) completed the interview. Poststroke fatigue was reported in 11.8 % (n = 38) of the population. Occupational status (χ2 = 5.73), functional mobility (χ2 = 5.84), and disability scores (χ2 = 8.00) were significantly associated (p < 0.05) with fatigue scores. Individuals with disability exhibited five times (OR = 5.00, CI: 1.45–17.23, p = 0.01) higher odds of experiencing fatigue than those without disability. ConclusionOur study reported a relatively lower prevalence of fatigue among community-living late subacute and chronic stroke survivors. Implementing strategies to address these contributing factors could effectively ease fatigue in individuals recovering from stroke.

Association between depression and adherence to upper limb exercises among community-dwelling stroke survivors: A cross-sectional study.

Upper limb recovery after stroke tends to be slower and incomplete. Participation in motor rehabilitation and exercise adherence are crucial to improve motor recovery. However, post-stroke depression (PSD) could impede active participation in exercises. Therefore, this study investigates the association between depression and exercise adherence among community-dwelling stroke survivors. This cross-sectional study was conducted among 215 stroke survivors undergoing motor rehabilitation between February 2021 and January 2023. Patient Health Questionnaire-9 (PHQ-9) and Stroke-Specific Measure of Adherence to Home-based Exercises (SS-MAHE) were measured to assess depression symptoms and exercise adherence, respectively. Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was administered to identify the influence of impairment on these factors. Chi-square and multinomial and binary logistic regression analyses were applied to determine the relationships between these measurements. Using the Chi-square test, the PHQ-9 was significantly associated with SS-MAHE (p < 0.05). Logistic regression analysis revealed that patients with moderate depression had lower odds of exercise adherence (OR:0.69, 95%CI:0.56, 0.85, p < 0.01) compared to those with no depression. Type of exercises such as movement-based (OR:2.00, 95%CI:1.80, 2.24, p < 0.001) and task-based exercises (OR:1.80, 95%CI:1.53, 2.13, p < 0.001), had higher adherence odds compared to those not exercising. Severe impairment (FMA-UE) was significantly associated with lower exercise adherence (OR:0.71, 95%CI:0.54, 0.94, p < 0.05) and an increased risk of minimal depression (RR:11.09, 95%CI:1.17, 105.04, p < 0.05) compared to mild impairment. PSD significantly impacts exercise adherence, with moderate depression notably reducing adherence rates. Incorporating mental health support into stroke rehabilitation could improve exercise adherence and potentially enhance upper limb motor recovery outcomes.

Post-rehabilitation programme to support upper limb recovery in community-dwelling stroke survivors: a mixed methods cluster-feasibility controlled trial

BackgroundLess than 50% of stroke survivors regain their pre-stroke level of upper limb function, compounded with a lack of long-term rehabilitation options available. The Graded Repetitive Arm Supplementary Programme (GRASP)...

Remote delivered cognitive rehabilitation programs in Acquired Brain Injury: a systematic review of methods and outcomes

Remote delivered cognitive rehabilitation programs (r-CRP) are increasingly recognized as alternative and complementary intervention approaches to traditional cognitive rehabilitation (CR) in the context of several neurological conditions, including acquired brain injuries (ABI). This systematic review examines the methodological characteristics of currently available r-CRP for ABI patients and investigates their impact on cognitive and noncognitive outcomes. A systematic search was performed on EBSCOhost, PubMed, and Web of Science, complemented by a manual search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration Guidelines were followed. Out of 1624 studies, a total of 19 studies were included. The results demonstrate that most r-CRP were administered to middle-aged community-dwelling chronic stroke survivors and that there was no consensus regarding assessment and intervention protocols. Moreover, most r-CRP were delivered through information and communication technologies (ICTs), primarily relying on cognitive training (CT) interventions addressing multiple cognitive domains (e.g., attention, memory). These ICT-based CT programs included tasks with low ecological validity, i.e., tasks with limited real-world application (e.g., cancelation tasks with artificial stimuli), and were asynchronous, meaning that participants performed the sessions at their own pace, without real-time monitoring from a therapist. In terms of the impact of r-CRP, class I studies reported mixed and inconsistent results regarding the effect of this mode of delivery on cognitive and noncognitive outcomes of ABI patients while supporting its high feasibility and acceptability among patients. Specific recommendations for future research are provided to improve the methodological quality of clinical studies and establish the evidence base for r-CRP.

In-person and online mixed method non-randomised studies exploring feasibility and acceptability of HEADS: UP, an adapted Mindfulness-Based Stress Reduction programme for stroke survivors experiencing symptoms of anxiety and depression

BackgroundDepression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial.MethodsWe recruited community-dwelling stroke survivors (SS) ≥ 3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥ 8). Participants could ‘enrol’ a family member/ ‘other’ to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In a pragmatic response to Covid-related socialising restrictions, HEADS: UP was then adapted for online delivery, tested in Study 2. The primary outcome (both studies) was the feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient-reported outcome measures (PROMs) assessing mood and quality of life) and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement.ResultsStudy 1Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, interquartile range (IQR) 14); male (n = 9; 69%); 28 (IQR 34) months post-stroke. Of these, n = 10 (76.9%) completed PROMS pre-intervention; n = 6 (46.2%) post-intervention.Acceptability: Nine (69.2%) of the 13 participants attended ≥ 4 core intervention sessions. Aspects of screening and data collection were found to be burdensome.Study 2Feasibility: SS n = 9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IQR 12); male (n = 4; 44.4%); 23 (IQR 34) months post-stroke. Of these, n = 5 (55.6%) completed PROMS pre-intervention; n = 5 (55.6%) post-intervention.Acceptability: Five (55.6%) of the 9 participants attended ≥ 4 core sessions. They found online screening and data collection processes straightforward.

Educational media utilization for rehabilitation among community-dwelling stroke survivors and their caregivers: a pilot study

Background: Recently, there has been an increasing number of stroke patients. Those who survive still need continuous rehabilitation after being discharged from the hospital. The information and knowledge on stroke rehabilitation at home is crucial for these patients and their caregivers. However, there has never been a study of educational media on rehabilitation for those patients and their caregivers in Thailand. Objective: To explore the educational media used in stroke rehabilitation, list their benefits, and the most satisfying media type for stroke participants and their caregivers after hospital discharge. Materials and methods: Twenty-eight stroke patients and twenty-one primary caregivers from two Subdistrict Municipalities and two Districts in Chaing Mai province were recruited using purposive sampling methods. All participants were aged 18 years and over and could communicate in Thai. All the stroke participants had no cognitive impairment screening by the Mental Status Examination-10 (MSET-10) and had self-rehabilitation therapy at home. A Questionnaire on the use of educational media in stroke rehabilitation with the index of item objective congruence (IOC) range between 0.67-1.00 was used for data collection. The statistics used were descriptive. Results: Stroke patients used information obtained primarily from medical personnel in the community (78.57%), while caregivers used advice from medical personnel the most in the hospitals (57.14%). Regarding the highest satisfaction with educational media, 59% of stroke patients and 42% of caregivers were satisfied with advice from medical personnel in the community. Stroke patients revealed that using a combination of advice from medical professionals, brochure-based media, and only document media was the most beneficial in providing knowledge about rehabilitation. For caregivers, the use of a combination of advice from medical professionals along with paper and video media, and the use of knowledge gained from online channels were the most beneficial. Conclusion: Rehabilitation education materials used by stroke patients and their caregivers at home offer the highest level of satisfaction for the patients and caregivers if the medium of people who can give advice and communicate on issues meets their needs. In addition, patients and caregivers agreed that rehabilitation education should include more than one form of media for maximum benefit. Therefore, health professionals should consider the format of educational media appropriate to the needs of service recipients to be able to use them most effectively.

Evaluation of Cost-Effectiveness of a Virtual Multidisciplinary Stroke Care Clinic for Community-Dwelling Survivors of Stroke.

A technologically integrated, multidisciplinary approach to stroke rehabilitation service was delivered and embedded into conventional health care practice. This article reports an evaluation of cost-effectiveness analysis of a new Virtual Multidisciplinary Stroke Care Clinic (VMSCC) service for community-dwelling survivors of stroke. A randomized controlled trial was conducted. Adults with a first/recurrent ischemic/hemorrhagic stroke were recruited from 10 hospitals. Eligible participants were randomly assigned to receive the VMSCC service (individual virtual consultations with a registered nurse, home blood pressure telemonitoring, and unlimited access to an online resource platform) plus usual care or usual care alone. Cost-effectiveness analyses were performed based on incremental cost-effectiveness ratios expressed as incremental cost per emergency admission reduced, and day of hospitalization reduced over the study period. A total of 256 participants (intervention group n=141 versus control group n=115) with complete cost and health care use data were included in the cost-effectiveness analyses. The VMSCC service, on average, resulted in a greater reduction in the number of emergency admission (-0.06 [95% bootstrapped CI, -0.14 to 0.01]) and fewer days of hospitalization (-0.08, [95% bootstrapped CI -0.40 to 0.24]) but incurred a higher total cost of HK$375 (95% bootstrapped CI, -2103 to 2743) compared with the usual care. The incremental cost-effectiveness ratios of the VMSCC service compared with the usual care were HK$6070 and HK$4826 per an emergency admission and a day of hospital stay reduced respectively. The study provides preliminary but not confirmative evidence that the VMSCC service could be more effective but more costly than usual care in reducing health service use. URL: https://www.chictr.org.cn. Unique identifier: ChiCTR1800016101.

Outcomes Among Mexican American and Non-Hispanic White Informal Stroke Caregivers.

Informal home care is prevalent among Mexican American stroke survivors, but data on the impact on caregivers are not available. The aim was to assess ethnic differences in informal stroke caregiving and caregiver outcomes at 90 days poststroke. Informal caregivers were recruited from the population-based Brain Attack Surveillance in Corpus Christi Project (2019-2023), conducted in a bi-ethnic community in Texas. Caregivers of community-dwelling stroke survivors who were not cognitively impaired and not employed by a formal caregiving agency were interviewed. Interviews included sociodemographics, dyad characteristics, Modified Caregiver Strain Index (range 0-26, higher more positive), Positive Aspects of Caregiving scale (range, 5-45, higher more), Patient Health Questionnaire-8 (range, 0-30, higher worse), and PROMIS (Patient-Reported Outcomes Measurement Information System)-10 physical (range, 16.2-67.7, higher better) and mental health (range, 21.2-67.6, higher better) summary scores. Stroke survivor data was from interviews and medical records. Propensity score methods were used to balance caregiver and patient factors among Mexican American and Non-Hispanic White caregivers by fitting a model with ethnicity of caregiver as the outcome and predictors being caregiver sociodemographics, patient-caregiver dyad characteristics, and patient sociodemographics and functional disability. Propensity scores were included as a covariate in regression models, considering the association between ethnicity and outcomes. Mexican American caregivers were younger, more likely female, and more likely a child of the stroke survivor than Non-Hispanic White caregivers. Mexican American caregiver ethnicity was associated with less caregiver strain (β, -1.87 [95% CI, -3.51 to -0.22]) and depressive symptoms (β, -2.02 [95% CI, -3.41 to -0.64]) and more favorable mental health (β, 4.90 [95% CI, 2.49-7.31]) and positive aspects of caregiving (β, 3.29 [95% CI, 1.35-5.23]) but not associated with physical health. Understanding the mechanisms behind more favorable caregiver outcomes in Mexican American people may aid in the design of culturally sensitive interventions to improve both caregiver and stroke survivor outcomes, potentially across all race and ethnic groups.

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada.

Secondary stroke preventive care includes evaluation and control of vascular risk factors to prevent stroke recurrence. Our objective was to evaluate the quality of ambulatory stroke preventive care and its variation by immigration status in adult stroke survivors in Ontario, Canada. We conducted a population-based administrative database-derived retrospective cohort study in Ontario, Canada. Using immigration records, we defined immigrants as those immigrating after 1985 and long-term residents as those arriving before 1985 or those born in Canada. We included community-dwelling stroke survivors 40 years and older with a first-ever stroke between 2011 and 2017. In the year following their stroke, we evaluated the following metrics of stroke prevention: testing for hyperlipidemia and diabetes; among those with the condition, control of diabetes (hemoglobin A1c ≤7%) and hyperlipidemia (low-density lipoprotein <2 mmol/L); medication use to control hypertension, diabetes, and atrial fibrillation; and visit to a family physician and a specialist (neurologist, cardiologist, or geriatrician). We determined age and sex-adjusted absolute prevalence difference (APD) between immigrants and long-term residents for each metric using generalized linear models with binomial distribution and an identity link function. We included 34,947 stroke survivors (median age 70 years, 46.9% women) of whom 12.4% were immigrants. The receipt of each metric ranged from 68% to 90%. Compared with long-term residents, after adjusting for age and sex, immigrants were slightly more likely to receive screening for hyperlipidemia (APD 5.58%; 95% CI 4.18-6.96) and diabetes (5.49%; 3.76-7.23), have visits to family physicians (1.19%; 0.49-1.90), receive a prescription for antihypertensive (3.12%; 1.76-4.49) and antihyperglycemic medications (9.51%; 6.46-12.57), and achieve control of hyperlipidemia (3.82%; 1.01-6.63). By contrast, they were less likely to achieve diabetes control (-4.79%; -7.86 to -1.72) or have visits to a specialist (-1.68%; -3.12 to -0.24). There was minimal variation by region of origin or time since immigration in immigrants. Compared with long-term residents, many metrics of secondary stroke preventive care were better in immigrants, albeit with small absolute differences. However, future work is needed to identify and mitigate the factors associated with the suboptimal quality of stroke preventive care for all stroke survivors.

Factors influencing physical activity levels in elderly community-dwelling convalescent stroke survivors: A cross-sectional study

AimThis study aimed to investigate factors affecting physical activity (PA) among elderly stroke survivors living in the community and assess the mediating role of exercise planning in the relationship between exercise self-efficacy and PA. Methods300 participants were surveyed using questionnaires and scales, with data analyzed using SPSS 26.0. ResultsUnivariate analysis identified sociological, disease-related factors, exercise self-efficacy, and exercise planning as influencing PA. Ordered logistic regression showed significant associations between PA, exercise self-efficacy (OR 1.093, 95 % CI 1.055–1.133, P < 0.001), and exercise planning (OR 1.296, 95 % CI 1.202–1.398, P < 0.001). Exercise planning partially mediated the relationship between exercise self-efficacy and PA, accounting for 64.86 % of the total effect. ConclusionsMultiple factors, including sociological and disease-related ones, as well as exercise self-efficacy and planning, influence PA in elderly stroke survivors. Exercise planning partially mediates the relationship between exercise self-efficacy and PA.

PEMOCS: theory derivation of a concept for PErsonalized MOtor-Cognitive exergame training in chronic Stroke-a methodological paper with an application example.

Coping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke. The development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the "Framework for Developing and Evaluating Complex Interventions" by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed. A training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2-3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept. We propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.

Community Participation Transition After Stroke (COMPASS) Randomized Controlled Trial: Effect on Adverse Health Events

ObjectiveTo compare adverse health events in intervention versus control group participants in the Community Participation Transition After Stroke trial to reduce barriers to independent living for community-dwelling stroke survivors. DesignRandomized controlled trial. SettingInpatient rehabilitation (IR) to home and community transition. ParticipantsStroke survivors aged ≥50 years being discharged from IR who had been independent in activities of daily living prestroke (N=183). InterventionsParticipants randomized to intervention group (n=85) received home modifications and self-management training from an occupational therapist over 4 visits in the home. Participants randomized to control group (n=98) received the same number of visits consisting of stroke education. Main Outcome MeasuresDeath, skilled nursing facility (SNF) admission, 30-day rehospitalization, and fall rates after discharge from IR. ResultsTime-to-event analysis revealed that the intervention reduced SNF admission (cumulative survival, 87.8%; 95% confidence interval [CI], 78.6%-96.6%) and death (cumulative survival, 100%) compared with the control group (SNF cumulative survival, 78.9%; 95% CI, 70.4%-87.4%; P=.039; death cumulative survival, 87.3%; 95% CI, 79.9%-94.7%; P=.001). Thirty-day rehospitalization also appeared to be lower among intervention participants (cumulative survival, 95.1%; 95% CI, 90.5%-99.8%) than among control participants (cumulative survival, 86.3%; 95% CI, 79.4%-93.2%; P=.050) but was not statistically significant. Fall rates did not significantly differ between the intervention group (5.6 falls per 1000 participant-days; 95% CI, 4.7-6.5) and the control group (7.2 falls per 1000 participant-days; 95% CI, 6.2-8.3; incidence rate ratio, 0.78; 95% CI, 0.46-1.33; P=.361). ConclusionsA home-based occupational therapist–led intervention that helps stroke survivors transition to home by reducing barriers in the home and improving self-management could decrease the risk of mortality and SNF admission after discharge from rehabilitation.

Occupational balance and stroke impact among community-dwelling stroke survivors 65 years or older: a cross-sectional study.

Occupational balance has been investigated in different populations but less in stroke survivors. Previous studies have focussed on occupational balance among stroke survivors of working age (15-64 years of age), showing they did not perceive they had occupational balance. There is, therefore, a lack of knowledge of how older stroke survivors perceive their occupational balance. The aims of this study were to describe occupational balance in community-dwelling stroke survivors 65 years or older and to investigate if there were any associations between their perceived stroke impact and occupational balance. A cross-sectional study was performed with 58 stroke survivors, with a median age of 75 years at stroke onset and a median time since stroke onset of 11 months. The participants were recruited from a local stroke register and answered questionnaires on occupational balance and stroke impact. Data were analysed with descriptive statistics, correlations and logistic regression. The participants had a median score of 29 (min 12 to max 33), indicating a very high occupational balance, a low stroke impact, and a good recovery (median 82.5; min 0 to max 100). An association between participation and occupational balance (OR 1.13; 95% CI 1.04-1.23) was found. The stroke survivors perceived a low stroke impact and a high occupational balance. It is possible that older community-dwelling stroke survivors, of whom many have retired, juggle less occupations leaving them with more time to engage in those occupations they want to, leading to a better occupational balance.

Gait Function and its Association with Functional Independence, Quality of Life, and Community Reintegration in Stroke Survivors.

Background and Aims: The major outcome of stroke rehabilitation is the recovery of the ability to walk. However, a large proportion of stroke survivors are discharged to the community with gait deficiency which impairs their functional independence, and quality of life increasing the burden of care on caregivers especially their lack of functioning in the community. This study assessed the gait functional performance in community-dwelling stroke survivors and explored its association with functional independence, quality of life, and community reintegration in community-dwelling stroke survivors. Materials and methods: This study involved 115(59 males and 56 females) community-dwelling stroke survivors. Their gait functional performance was assessed using the 10-meter walk test (10MWT) while their functional independence was assessed with the functional independence measure (FIM). Their quality of life (QoL) was assessed using the Stroke-specific QoL scale while community functioning and productivity were assessed using the community integration questionnaire (CIQ). Their scores on the assessments were compared with the normative data of their age and sex-matched healthy individuals. Data was analysed using Spearman’s correlation coefficient and Chi-Square at p&lt;.05. Results: Participants’ ages ranged between 27 to 78 years (mean=60.48±37.84 years). More participants (56.7%) had right hemispheric lesions and 43.3% had lesions in the left hemisphere. Their gait function, functional independence performance, QoL, and community reintegration functions were significantly (p&lt;0.05) lower than their age and sex-matched normative data. There was a significant (p&lt;0.05) association and relationship between their gait functional performance and each of the functional independence performance, QoL, community reintegration, and productivity. Conclusion: Gait functional performance in community-dwelling stroke survivors is significantly lower than in age and sex-matched healthy individuals and it is significantly associated with low functional independence performance, low quality of life, poor community functioning, and lack of productivity in stroke survivors, Abnormal gait pattern is related to poor functional independence, poor quality of life and low productivity.

What influences stroke survivors with physical disabilities to be physically active? A qualitative study informed by the Theoretical Domains Framework.

Although the benefits of regular physical activity (PA) after stroke are well established, many stroke survivors do not achieve recommended PA levels. To date, studies exploring determinants to PA have not used a behaviour change theory and focused on stroke survivors with physical disabilities. As a precursor to an intervention development study, we aimed to use the Theoretical Domains Framework (TDF) to identify factors influencing PA in stroke survivors with physical disabilities in Singapore. Between November 2021 and January 2022, we conducted interviews with 19 community-dwelling stroke survivors with a weak arm and/or leg. An interview guide based on the TDF was developed. We analysed the data deductively by coding interview transcripts into the theoretical domains of the TDF, and then inductively by generating themes and belief statements. To identify relevant TDF domains, we prioritised the domains based on the frequencies of the belief statements, presence of conflicting belief statements and evidence of strong belief statements. Eight of the 14 TDF domains were relevant, and included environmental context and resources, knowledge, social influences, emotion, reinforcement, behavioural regulation, skills and beliefs about capabilities. The lack of access, suitable equipment and skilled help often limited PA participation at public fitness spaces such as parks, gyms and swimming pools (environmental context and resources). While a few stroke survivors expressed that they had the skills to engage in regular PA, most expressed not knowing how much and how hard to work, which exercises to do, which equipment to use and how to adapt exercises and equipment (knowledge and skills). This often left them feeling afraid to try new activities or venture out to new places for fear of the unknown or adverse events (e.g., falls) (emotion). For some, doing the activities in a group encourage them to get out and engage in PA (social influences). In stroke survivors with physical disabilities, environmental context and resources had a significant influence on PA participation, and this often had a spill over effect into other domains. Our results inform a complex behaviour change intervention to improve PA after stroke, and has implications for intervention design for people with physical disabilities.

Associations of Circadian Rest-Activity Rhythms With Affect and Cognition in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Study

Background Rest-activity rhythm (RAR) is a modifiable behavioral factor associated with affect and cognition. Identifying RAR characteristics associated with affect and cognition among stroke survivors provides insight into preventing poststroke affective and cognitive impairment. Objective To examine the associations of RAR characteristics with affect and cognition among community-dwelling stroke survivors. Methods Forty participants with mild stroke (mean age = 52.8; 42.5% female; 55% White) reported their affect and cognitive complaints using ecological momentary assessment and wore an accelerometer for 7 consecutive days and completed the National Institutes of Health Toolbox Cognition Battery. RAR characteristics were extracted using parametric and non-parametric approaches. Multivariable linear regressions were used to identify RAR characteristics associated with affect and cognition. Results Later onset of rest (B = 0.45; P = .008) and activity (B = 0.36; P = .041) were positively associated with depressed affect. These associations were reversed for cheerful effect (rest onset: B = −0.42; P = .017; activity onset: B = −0.39; P = .033). Cheerful affect was also positively associated with relative amplitude (ie, distinctions in activity levels between rest and activity; B = .39; P = .030). Intra-daily variability (ie, RAR fragmentation; B = 0.35; P = .042) and later onset of activity (B = .36; P = .048) were positively associated with cognitive complaints. Less erratic RAR was positively associated with fluid cognition (B = 0.29; P = .036); RAR fragmentation was positively associated with crystallized cognition (B = 0.39; P = .015). Conclusions We identified RAR correlates of affect and cognition among stroke survivors, highlighting the value of managing RAR and sleep in stroke rehabilitation. Future studies should test whether advancing the onset of rest and activity, promoting a regular active lifestyle, and improving rest and sleep in the nighttime protect stroke survivors from affective and cognitive impairment.

Abstract HUP15: An Exploring Qualitative Study of Real Life Experiences and Needs of Psychosocial Recovery Among Chinese Community Dwelling Stroke Survivors

Introduction: Stroke survivors may face challenges in managing their psychosocial functions. However, little is known about psychosocial experiences and needs of community-dwelling stroke survivors, particularly in China. Purpose: This study explored the experiences and needs of psychosocial recovery among Chinese community-dwelling stroke survivors. Methods: Semi-structured and individual interviews were conducted with participants in Macao from community healthcare centers and supported groups using convenience sampling. Participants were asked about their experiences, challenges, and strategies for managing post-stroke psychosocial functions, and desired support for psychosocial recovery. Interview data were transcribed verbatim and analyzed thematically. Results: Twenty-six participants (mean age: 69.96±14.06 years old; mean post-stroke duration: 83.88±66.8 months) were recruited to participate in interviews. Regarding the experiences and challenges, most participants faced obstacles in managing emotions and barriers to rebuilding social lives due to the impacts of physical disabilities. Generally, most participants recognized that they were a minority of people in society, and some experienced further invalidation by society. The majority of participants lost motivation and expectations to face challenges, hesitated to disclose their conditions to others, and had less confidence in social interactions as they felt that they were different from others. Meanwhile, some participants adopted strategies to improve their psychosocial functions, including appreciation for oneself and important persons or events supporting them, adjustments to the disparity between expectations and reality, and reinterpretations of unpleasant experiences. Furthermore, communal creative activities offered by health professionals and peer support were recommended. Conclusion: To promote post-stroke psychosocial recovery in communities, health professionals should consider designing meaningful group activities for stroke survivors to meet their psychosocial needs. These findings will guide the development of interventions for enhancing psychosocial functions among Chinese community-dwelling stroke survivors.