Participation Of Stroke Survivors Research Articles

Assessing Participation in Stroke Survivors: Psychometric Properties of the Participation Measurement Scale (PM-Scale) Brazil.

Initial evidence supports the reliability of the Participation Measurement Scale (PM-Scale) in Brazil, but further exploration of its psychometric properties is needed for Brazilian stroke survivors. The aim of the study is to analyze the reliability, convergent validity, internal consistency, and accuracy of the PM-Scale Brazil. A methodological study involved three assessments over intervals of 7-14 days. Reliability was evaluated through the Intraclass Correlation Coefficient. Convergent validity was assessed using Spearman's correlation coefficient to evaluate the alignment of the PM-Scale Brazil with the SATIS-Stroke. Internal consistency was assessed through Cronbach's α. Accuracy was estimated by calculating the area under the receiver operating characteristic curve. The study involved 110 stroke survivors, revealing adequate intra-rater and inter-rater reliability. A significant weak correlation was observed between the PM-Scale and SATIS-Stroke. Internal consistency and accuracy were adequate. The PM-Scale Brazil demonstrates good reliability, internal consistency, and sensitivity. However, its weak correlation with SATIS-Stroke suggests limited convergent validity.

Relationship between Participation in Daily Life Activities and Physical Activity in Stroke Survivors: A Protocol for a Systematic Review and Meta-Analysis.

Stroke survivors undertake low levels of physical activity and participation in daily life activities, but the correlation between these two domains still carries some degree of uncertainty. This systematic review and meta-analyses-based data synthesis will aim to describe and estimate the relationship between participation in daily life activities and physical activity in stroke survivors. Six databases (MEDLINE/PubMed, Web of Science, Scopus, PEDro, SPORTDiscus, and Rehabilitation & Sport Medicine Source) will be searched. Studies assessing participation alongside physical activity levels in adult stroke survivors in English or Spanish will be included. The study selection, assessment of the risk of bias, and data extraction will be conducted independently by two investigators. If available, correlation values between physical activity and participation outcomes will be extracted. The Hedges-Olkin method will be used for pooling correlation values between participation and physical activity measures. Subgroup analyses will be performed according to the time elapsed since the stroke (i.e., ≤6 months and >6 months). This will be the first systematic review with a meta-analysis to provide information on the relationship between physical activity and participation in stroke survivors. Findings are likely to inform the design of health prevention protocols and the development of healthy behavior change interventions.

Translation and cross-cultural adaptation of the Brazilian version of the PM-Scale: A specific measure of participation after stroke

BackgroundThe PM-Scale was developed specifically to assess participation in individuals after stroke based on the concepts contained in the International Classification of Functioning, Disability and Health. However, this measure is only available in English and French. ObjectiveTo translate and cross-culturally adapt the PM-Scale to Brazilian Portuguese, followed by the validation and testing of reliability of the translated version. MethodsThe translation process followed standard guidelines. Preliminary test-retest reliability was determined using the intraclass correlation coefficient (ICC2,1). The Rasch model was employed to analyse the validity, unidimensionality, invariance, and internal consistency of the Brazilian version of the PM-Scale. ResultsThe final translated version of the PM-Scale presented appropriate semantic, idiomatic, cultural, and conceptual equivalence. The preliminary analysis revealed excellent intra-observer and inter-observer reliability (ICC2,1 = 0.91; 95%CI: 0.83, 0.95 and ICC2,1 = 0.81; 95%CI: 0.64, 0.89, respectively). The analysis of the Rasch model revealed only one erratic item. An excellent overall fit was found for items (mean ± SD = 0.01 ± 1.02) and adequate fit was found for persons (mean ± SD = 1.16 ± 0.88). Internal consistency was considered adequate (person separation index = 1.77, reliability = 0.76). No significant invariance was found with regards to the personal characteristics of the sample (p > 0.05). ConclusionThe Brazilian version of the PM-Scale is a valid, unidimensional, linear, reliable scale for measuring participation in stroke survivors and can be administered in less than five minutes.

The mediating effect of anxiety on the association between residual neurological impairment and post-stroke participation among persons with and without post-stroke depression

ABSTRACT Previous research has reported that residual neurological impairment and emotional factors play a role in regaining successful participation post-stroke. The objective of this study was to investigate the mediating impact of anxiety on the association between residual neurological impairment and participation in survivors with and without post-stroke depressive symptoms. Participants (N = 79) were classified into 2 categories, those with post-stroke depressive symptoms (N = 40) and those without post-stroke depressive symptoms (N = 39). Variables measured in this study: residual neurological impairment (NIH Stroke Scale Score), participation (Reintegration to Normal Living Index), depressive symptoms (Patient Health Questionnaire-9), and trait anxiety (State-Trait Anxiety Inventory). A regression-based mediation analysis was conducted for each group of participants. The majority of participants had some level of anxiety. Residual neurological impairment predicted participation in stroke survivors both with (β = -.45, p = .003) and without (β = -.45, p = .004) post-stroke depressive symptoms. Anxiety mediated this relationship in participants with depressive symptoms (β = -.19, 95% CI = -.361 ∼ -.049), but not in participants without depressive symptoms (β = -.18, 95% CI = -.014 ∼ .378). Depressive and anxious symptoms should both be addressed to best facilitate participation by stroke survivors.

Association between participation self-efficacy and participation in stroke survivors

BackgroundMost stroke survivors face restrictions in functional disability and social participation, which can impede their recovery and community reintegration. Participation self-efficacy refers to survivors’ confidence in using strategies to manage participation in areas including community living and work engagement. This study aimed to assess the association between participation self-efficacy and participation among stroke survivors.MethodsThis study adopted a cross-sectional correlational design with a convenience sample of 336 stroke survivors recruited from five hospitals in China. Participation self-efficacy was measured using the Chinese version of the Participation Strategies Self-Efficacy Scale (PS-SES-C) and participation measured using the Chinese version of the Reintegration to Normal Living Index (RNLI-C). The association between participation self-efficacy and participation was examined using multiple regression analysis with adjustment for potential confounders.ResultsParticipants had a mean age of 69.9 ± 11.5 years, with most (81.6%) having an ischaemic stroke, and more than half (61.6%) a first-ever stroke. After adjustment for potential confounders, every 10-point increase in the PS-SES-C total score was significantly associated with an average 1.3-point increase in the RNLI-C total score (B = 1.313, SE = 0.196, p < 0.001).ConclusionsThis study demonstrates that participation self-efficacy is significantly associated with participation among Chinese community-dwelling survivors of a mild or moderate stroke. This suggests that rehabilitation programmes for stroke survivors may be more effective if they incorporate participation-focused strategies designed to enhance self-efficacy.(229 words).

Effects of computerized cognitive training on cognitive function, activity, and participation in individuals with stroke: A randomized controlled trial.

Computerized cognitive training (CCT) is an emerging alternative intervention for stroke survivors. This study investigated the effects of CCT on the cognition, activity, and participation of stroke survivors and compared the findings with those of match-dosed conventional cognitive training. This randomized controlled trial included 39 patients with stroke who were divided into the intervention group (n = 19; receiving CCT with Lumosity software) and the control group (n = 20; receiving conventional cognitive training). Both the groups were trained for 20 min, twice a week, for 12 weeks. Participants were evaluated at pretest, posttest, and 4-week follow-up. Outcome measures included various cognitive function tests and the Stroke Impact Scale scores. The CCT group exhibited significant improvement in global cognitive function (evaluated using the Mini-Mental State Examination and Montreal Cognitive Assessment) and specific cognitive domains: verbal working memory (backward digit span test), processing speed (Symbol Digit Modalities Test), and three MoCA subtests (attention, naming, and delayed recall). CCT exerted no significant effect on activities and participation. No significant between-group differences in changes in cognitive function were noted. However, CCT significantly improved cognitive function domains immediately after training, and these effects were sustained at the 4-week follow-up. Cognitive function of individuals with chronic stroke could improve after administration of CCT. However, future studies with a more rigorous design and higher training dose are warranted to validate our findings.

The effect of self-management programs on post-stroke social participation: A systematic review and meta-analysis

Objective The aim of this study was to identify the effectiveness of self-management programs on the improvement of social participation among stroke survivors. Data Sources: Cochrane Library, PubMed, Web of Science database, EMBASE, Medline, CINAHL plus, and APA PsycArticles were searched from their inception to December 20, 2021. Methods We considered randomized controlled trials and non-randomized controlled trials without language limits. Two reviewers independently screened the literature, evaluated risk of bias using the Cochrane’s risk of bias tool, scored the methodological quality using criteria of the Australian Evidence-based Health Care Center, and extracted the data. The outcome was social participation. RevMan 5.3 was used, and intergroup differences were determined by calculating standardized mean difference (SMD) and 95% confidence intervals (CIs). Results Of 1894 initial studies, totally 15 studies met the eligible criteria, consisting of six randomized controlled trials and nine non-randomized controlled trials. Four randomized controlled trials showed high methodological quality and two demonstrated medium quality. The randomized controlled trials involved a total of 430 stroke survivors and were published between 2007 and 2020. The meta-analysis from five randomized controlled trials demonstrates that the overall effect of self-management programs on social participation was not statistically significant (95% CI, -0.23 to 0.40; p = 0.61). Most of the non-randomized controlled trials were pre-/post-test design with an average sample size of 15.4. The effect of self-management program on social participation in most non-randomized controlled trials was insignificant as well. Conclusion The self-management programs seem not to be superior to usual care for the improvement on social participation in stroke survivors based on current evidence. Further well-designed investigation considering social participation as the primary outcome is still warranted.

Italian translation and cross-cultural validation of an assessment tool for participation in stroke survivors: the Frenchay Activities Index.

Participation needs to be assessed objectively, to state accurate rehabilitation objectives. The Frenchay Activities Index (FAI) is a widely used tool to measure participation in stroke patients. To date, no cross-culturally validated Italian version of FAI is available. This study provides a translation and cross-cultural adaptation of FAI into Italian, assessing its validity and reliability in sub-acute stroke patients. According to international guidelines, a multistep translation and cultural adaptation protocol of forward and backward translations was conducted by qualified linguists and independent native English translators and revised by a healthcare committee. Patients admitted to intensive inpatient rehabilitation after stroke were recruited. Structural validity, reliability (internal consistency, inter- and intra-rater reliability and measurement error), and construct validity were studied. One hundred and seventy-three patients were included in this study. No significant observations in terms of comprehensibility and conceptual equivalence of the FAI Italian version emerged. The exploratory factorial analysis revealed the presence of two subscales (i.e., domestic chores and work/leisure). The internal consistency resulted good for the first and second subscale (α = 0.821 and 0.716, respectively). Intra- and inter-reliability showed an ICC > 0.90 for both subscales. SEM = 5.75% and 2.33% and MDC = 15.85% and 6.48% were found for the first and second subscale, respectively. Construct validity of first subscale was satisfactory, as 100.0% a priori hypotheses were met, while for the second subscale it was moderate, as 66.6% a priori hypotheses were respected. FAI-I provides a tool for professionals to measure participation in Italian stroke patients in health and social care settings.

Association of Walking Ability In Relation to Participation In Stroke Survivors: A Cross Sectional Study

Background: Stroke is a neurological condition caused by an immediate injury to the CNS due to vascular sources like cerebral infarction, intracerebral haemorrhage, or subarachnoid haemorrhage. Stroke leads to changes in cognitive and psychological functioning, body disabilities and profound fatigue. After a stroke, patients are likely to produce an asymmetric gait pattern, decreased gait speed and decreased cadence. This leads to restricted independence and participation in the community and social activities. The aim of the study is to analyse the correlation between walking ability and measures of social participation. Methodology: Forty subjects were screened for inclusion criteria. They were explained about the procedure and gained informed consent for all the tests of walking ability and questionnaires were given for analysing their participation in social life activities. Walking ability was analysed by using 6-minute walk test, 10-meter walk test, Fall Efficacy Scale (FES), and Functional Ambulation Category (FAC). Social participation was analysed by using 3 questionnaires -POPS, IPAQ, and PARTS/M. Spearman correlation analysis was done to analyse the relationship between walking ability and domains and dimensions of social participation. Results: The correlation analyses revealed that the walking ability measured by 6-minute walk test, 10-meter walk test, FES and FAC scores correlate with the domains and dimensions of social participation by using the questionnaires-POPS, PARTS/M and IPAQ. Measures of walking ability i.e., 6-minute walk test were correlated with satisfaction (r=0.312; p&lt;0.05); FES with satisfaction (r=-0.396; p&lt;0.05); FAC with satisfaction (r=0.436; p&lt;0.05) dimensions of social participation. Measures of walking ability i.e., 10-meter walk test were correlated with major life area domain (r =-0.407; p&lt;0.5); FES and general tasks and demands (r=-0.334; p&lt;0.05); FAC and general tasks and demand domain (r=0.327; p&lt;0.05). Conclusion: Walking ability was significantly correlated with measures of domains and dimensions of social participation. KEYWORDS: Stroke, POPS, PARTS/M, CVA, Social Participation, Walking Ability.

Developing Personas to Inform The Creation of Novel Interventions to Improve Participation Among People With Stroke During COVID-19

Research ObjectivesPeople living with disabilities have been found to experience reduced participation during the COVID-19 pandemic. In order to inform interventions to improve physical activity and social participation in stroke survivors, we created personas to inform the design and development of products targeting stroke patients during life-changing events such as pandemics after strokeDesignPersona development methodology using qualitative interview data. The personas were developed by mapping participants to behavioural variables identified from coded transcripts. After identifying behaviour patterns, characteristics and goals were synthesized.SettingVirtual-data collection via Zoom; community.ParticipantsCommunity-dwelling individuals who have had a stroke (n = 26) were recruited. We included participants 19 years of age or older and if they were able to communicate in English. Participants were excluded if they had moderate or severe cognitive impairment or aphasia.InterventionsN/A.Main Outcome MeasuresN/A.ResultsOur analysis identified 6 distinct personas that reflect participant behaviours and goals in regard to participation during COVID-19. 1) “The Community Provider” likes to feel involved and wants to engage in daily life. 2) “The Homebody” enjoys alone time but lacks a daily routine. This persona aims to feel motivated to accomplish personal goals. 3) “The Independent” seeks to be an active and integrated part of the community without physical or situational restrictions. 4) “The Lifestyle Person” wants to live the good life and do whatever they want, whenever they want. 5) “The Contributor” wants to feel needed and wants to be responsible for helping in the community. 6) “The Health-Literate Participator” wants to be on top of things and stay healthy for their family and themselves.ConclusionsThe personas highlight behaviours and goals in stroke patients towards physical activity and social participation during COVID-19. The personas will help guide the development of interventions to improve physical activity and social participation. The interventions will be developed based on the behaviours and goals of those living with stroke.Author(s) DisclosuresN/A.

Clinical efficacy of aerobic exercise combined with computer-based cognitive training in stroke: a multicenter randomized controlled trial

ABSTRACT Purpose The objectives are to evaluate the effects of a sequential combination of aerobic exercise and cognitive training, compared with exercise or cognitive training alone, on cognitive function, physical function, daily function, quality of life, and social participation in stroke survivors with cognitive impairment. Methods This is a single-blind, parallel, randomized controlled trial. Stroke patients with mild cognitive impairment (n = 56) were randomly assigned to aerobic exercise training (n = 18), computerized cognitive training (n = 18), and the sequential combination of aerobic exercise and computerized cognitive training (n = 20) group. All groups underwent training 60 min/day, 3 days/week, for a total of 12 weeks. The primary outcomes included Montreal Cognitive Assessment (MoCA), Wechsler Memory Scale-Third Edition, and the Stroop color-word test. Secondary outcomes were the Timed Up and Go test, 6-Minute Walk Test, Functional Independence Measure, Lawton Instrumental Activities of Daily Living Scale, Community Integration Questionnaire, and Stroke Impact Scale. Results 56 participants completed the trial. Compared with a single type of aerobic exercise or cognitive training, the combined training group showed significant improvement in MoCA (P < .05, η2 = 0.13), and two sub-tests in WMS-III (both P’s < 0.05) following the intervention. However, no between-group differences were observed for physical functions, daily function, quality of life, and social participation measures. Conclusions The findings provide evidence for the potential synergistic intervention in stroke survivors. Future studies investigating the transfer effects and the optimal training parameters with a larger sample is needed.

Cognitive and Motor Predictors of Daily Life Monitoring for Stroke Survivors Using Mobile Health Technology

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. We examined cognitive and motor factors predicting adherence to smartphone-based ecological momentary assessment (EMA) for monitoring daily life participation in stroke survivors. Cognitive flexibility and dexterity were significant predictors of EMA adherence. We derived cutoff values to differentiate survivors with high and low adherence. OTs may use them to guide the selection of survivors who can use mobile health technology to monitor poststroke functioning. Primary Author and Speaker: Shijia Li Additional Authors and Speakers: Stephen C. L. Lau, Joanne N. Chin Contributing Authors: Alex Wong

Validation of a translated Chinese version of the Participation Strategies Self-Efficacy Scale: a cross-sectional study

Purpose To examine the psychometric properties of a Chinese version of the Participation Strategies Self-Efficacy Scale (PS-SES) among stroke survivors. Methods The PS-SES was translated into Chinese. A cross-sectional descriptive study was conducted with 336 stroke survivors recruited from the neurology departments of five hospitals in China. Reliability, concurrent validity, and construct validity of the scale were determined. Results The Chinese version of the PS-SES (PS-SES-C) showed good internal consistency and test–retest reliability, with a Cronbach’s α of 0.98 and an intraclass correlation coefficient of 0.79. There was a moderate to strong positive correlation between the PS-SES-C and Chinese version of the General Self-Efficacy Scale (r = 0.59, p < .001), positive correlations between the PS-SES-C and Chinese versions of the Modified Barthel Index (r = 0.59, p < .001), Rivermead Mobility Index (r = 0.70, p < .001), and Reintegration to Normal Living Index (r = 0.70, p < .001), and a negative correlation between the PS-SES-C and National Institutes of Health Stroke Scale (r = −0.63, p < .001). Known-group validity and factorial validity were also supported. Conclusions The PS-SES-C is a reliable and valid instrument for assessing self-efficacy in managing the participation of Chinese stroke survivors. Implications for rehabilitation Self-efficacy significantly predicts activity and participation in stroke survivors and is a major outcome measure in many stroke rehabilitation programmes. The translated Chinese version of the Participation Strategies Self-efficacy Scale is a valid and reliable tool to evaluate stroke survivors’ self-efficacy in managing participation. The Chinese version of the Participation Strategies Self-efficacy Scale can be used to assess stroke recovery among the Chinese population in clinical and research settings.

Hard return: the development and transformation process of social participation in stroke survivors; a qualitative study and initial theory

Objectives: Given the characteristic of high disability rates, the successful return of stroke patients to society is increasingly becoming a serious challenge. This study aimed developing a theory to reveal the development and transformation process of social participation among stroke survivors as a foundation for creating strategies to improve their social participation. Design: A constructivist grounded theory approach using data from in-depth semi-structure interviews. Setting: The settings were various, including the stroke follow-up clinic, rehabilitation institutions, subjects’ homes, park, work unit, and rest home in Shanghai, China. Subjects: In all, 36 stroke survivors who have passed through the acute phase and returned home participated in this study to share their experiences of social participation and processes of changes from September 2017 to January 2019. Results: A substantive theory on the development and transformation process of social participation among stroke survivors was generated, which included four process ingredients: “in-orbit,” “off-orbit,” “returning orbit,” and “in-orbit again.” The core concept “hard return” revealed not only the tough development process but also the unsatisfactory change results. Both participation abilities and participation willingness had an important impact on social participation and also played a significant role in driving its development. Conclusion: This study has identified the development process of social participation in stroke survivors and “hard-return” suggests not only the tough process but also unsatisfactory results. Interventions targeted process ingredients seem to be potentially promising to improve stroke survivors’ social function outcomes.

Activity and participation in stroke survivors in a low-income setting: A cross-sectional study.

To describe patients' activity and participation levels and to compare these levels across different groups of stroke survivors according to their walking speed (WS). In this cross-sectional study, 67 stroke survivors (43 men, mean age: 58.4 ± 12.9 years old) were assessed using the stroke impairment assessment set (SIAS), ACTIVLIM-Stroke, 10-m walk test (10MWT), 6-min walk test (6MWT) and Reintegration to Normal Living Index (RNLI). The sample was afterwards split into three WS sub-groups (<0.4 m/s, 0.4-0.8 m/s and >0.8 m/s) based on 10MWT scores. ACTIVLIM-Stroke, 10MWT and 6MWT mean scores (±SD) were, respectively, 69.4 ± 20.2%, 0.9 ± 0.6 m/s and 282.1 ± 182 m. RNLI median score (range) was 5 (0-20). Sub-group analyses indicated that 26.9% (n = 18) obtained WS < 0.4 m/s, 13.4% (n = 9) WS between 0.4 and 0.8 m/s, and 59.7% (n = 40) WS > 0.8 m/s. Significant differences (p < .001) were found between WS sub-groups for both activity and participation. Stroke survivors in Kinshasa presented a good performance for basic-activities of daily life (basic-ADLs). However, some of them still had difficulties with some community activities. Differences in WS seemed to discriminate well stroke survivors in terms of activity and participation, since the higher WS, the more they performed in basic-ADLs, walking distance and participation, and inversely.

Italian Translation and Transcultural Validation of Two Tools Assessing Participation in Stroke Survivors: the Frenchay Activity Index and the Walking Handicap Classification (FAIWHC)

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Translation and Cross-Cultural Adaptation of SATIS-Stroke for Use in Brazil: A Satisfaction Measure of Activities and Participation in Stroke Survivors.

Introduction SATIS-Stroke was developed to measure satisfaction regarding activities and participation among stroke survivors based on the concepts contained in the International Classification of Functioning, Disability, and Health. However, this measure is only available in English and French. Objective Perform the translation and cross-cultural adaptation of SATIS-Stroke to Brazilian Portuguese and test the preliminary reliability of this measure. Methods The translation process followed standardized guidelines and consisted of six phases: initial translation, back-translation, analysis of expert committee, test of final version, submission, and assessment of all written reports. To test the preliminary test-retest reliability, the measure was administered by a single observer on two occasions with an interval of 7 to 14 days for the determination of intraobserver agreement and administered again by a second observer for the determination of interobserver agreement. Reliability was analyzed using the intraclass correlation coefficient (ICC2,1) and respective 95% confidence intervals (CI). Results All stages of the cross-cultural adaptation process were respected and the final translated version of SATIS-Stroke exhibited semantic, idiomatic, cultural, and conceptual equivalence to the original version. The preliminary analysis revealed excellent intraobserver and interobserver reliability (ICC = 0.93; 95% CI: 0.83-0.97, p = 0.001 and ICC = 0.90; 95% CI: 0.74-0.96; p = 0.001, respectively). The items demonstrated adequate internal consistency, although ceiling and floor effects were considered beyond acceptable standards for some items. In the exploratory factor analysis, three factors were extracted that aggregated more than one construct to each component, but all were related to the “Activities and Participation” component of the International Classification of Functioning, Disability, and Health. Conclusion The final version of the SATIS-Stroke scale in Brazilian Portuguese proved to be adequate and reliable for use on the Brazilian population. Further studies are underway to give continuity to the validation process and analyze the others measurement properties of the scale in the Brazilian population.

Effects of Somatosensory Impairment on Participation After Stroke.

Our objective was to determine the effect of loss of body sensation on activity participation in stroke survivors. Participants (N = 268) were assessed at hospital admission for somatosensory and motor impairment using the National Institutes of Health Stroke Scale. Participation was assessed using the Activity Card Sort (ACS) in the postacute phase. Between-group differences in activity participation were analyzed for participants with and without somatosensory impairment and with or without paresis. Somatosensory impairment was experienced in 33.6% of the sample and paresis in 42.9%. ACS profiles were obtained at a median of 222 days poststroke. Somatosensory loss alone (z = 1.96, p = .048) and paresis in upper and lower limbs without sensory loss (z = 4.62, p < .001) influenced activity participation. Somatosensory impairment is associated with reduced activity participation; however, paresis of upper and lower limbs can mask the contribution of sensory loss.

Long-term restrictions in participation in stroke survivors under and over 70 years of age

Purpose: This study aims to (1) assess differences in participation restrictions between stroke survivors aged under and over 70 years and (2) identify predictors associated with favorable and unfavorable long-term participation in both age groups.Methods: Prospective cohort study in which 326 patients were assessed at stroke onset, two months and one year after stroke. The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) was used to measure participation restrictions one year after stroke. Bivariate and multivariate logistic regression analyses were performed including demographic factors, stroke-related factors, emotional functioning and comorbidity as possible predictors.Results: Stroke survivors aged over 70 years perceived more participation restrictions in comparison to stroke survivors aged under 70 years one year after stroke. Independently significant predictors for unfavorable participation outcomes were advancing age, more severe stroke and anxiety symptoms in patients aged over 70 years, and female gender, more severe stroke, impaired cognition and depression symptoms in patients aged under 70 years. Lower age was the only independent predictor associated with favorable participation after one year in stroke survivors aged over 70 years.Conclusions: This study emphasizes the need to pay more attention to participation restrictions in elderly stroke survivors.Implications for rehabilitationMore attention in the rehabilitation process should be paid to restrictions in participation of stroke survivors aged older than 70 years, taking into account the different participation needs and predictors of older stroke survivors.Early screening on the presence of anxiety symptoms could potentially prevent long-term restrictions in participation in stroke survivors aged over 70-year old.Stroke survivors experience considerable restrictions in physical activity and mobility after one year, highlighting the need for the development of community-based exercise programs for stroke survivors.

Impact of social support on participation after stroke in Nigeria

Background: Participation which entails involvement in life situations and represents a higher level of functioning can be severely restricted after a stroke. This study investigated the impact of social support on participation of stroke survivors in Nigeria.Methods: Ninety-six community-residing stroke survivors were recruited from physiotherapy outpatient departments of two tertiary care hospitals in Northern Nigeria. Socio-demographic, clinical, participation (London Handicap Scale), and social support (Multidimensional Scale of Perceived Social Support) data were obtained. The impact of social support on global and domain-specific participation was examined using bivariate analyses and multiple regression analyses.Results: Mean (SD) age of the stroke survivors was 56.6 (12.0) years. Social support was a significant (β = 0.41, p < 0.0001) and independent determinant of the economic self-sufficiency domain of participation (p < 0.0001) in a regression model that accounted for 27% of the variance in the domain (R2 = 0.27). Social support, however, had no independent effect on overall participation and the other participation domains namely mobility, physical independence, occupation, social integration, and orientation.Conclusion: The impact of social support was significant only in the economic self-sufficiency domain of participation with higher availability of social support related to better economic self-sufficiency. This finding provides additional information on the importance of social support post-stroke.