Does the frequency of participation change after stroke and is this change associated with the subjective experience of participation?

Objective: To investigate changes in the frequency of participation 6 months poststroke compared with prestroke; and to establish whether the change is associated with participation restrictions and satisfaction with participation 6 months poststroke.

Design: Inception cohort study. Prestroke frequency of participation was measured retrospectively in the first week poststroke. Frequency, participation restrictions, and satisfaction with participation were assessed 6 months poststroke.

Setting: General hospitals and home residences.

Participants: Patients with stroke (N=325; 65.5% men; mean age, 66.9±12.2y) admitted to 1 of 6 participating general hospitals.

Interventions: Not applicable.

Main Outcome Measure: Utrecht Scale for Evaluation of Rehabilitation-Participation (0-100), which consists of 3 scales: frequency, restrictions, and satisfaction. The frequency scale consists of 2 parts: vocational activities (work, volunteer work, education, household activities) and leisure and social activities.

Results: Vocational activities showed a large decrease (effect size: 0.6) poststroke; leisure and social activities showed a small decrease (effect size: 0.13) poststroke. In multiple regression analyses, both the frequency of participation in vocational activities 6 months poststroke and the decrease in vocational activities compared with before the stroke were significantly associated with the participation restrictions experienced and satisfaction with participation after controlling for age, sex, level of education, dependency in activities of daily living, cognitive functioning, and presence of depressive symptoms. The presence of depressive symptoms showed the strongest association with the subjective experience of participation.

Conclusions: The frequency of participation decreased after a stroke, and this decrease was associated with participation restrictions experienced and satisfaction with participation. Resuming vocational activities and screening and, if applicable, treatment of depressive symptoms should be priorities in stroke rehabilitation.