Perceived Strengths and Needs After Rehabilitation in Community-Dwelling Adults With Chronic Stroke

PURPOSE: The purposes of this study were (1) to evaluate self-perceived impact of injury on activity performance and satisfaction among individuals with chronic stroke after receiving services at a community-based support center and (2) to compare self-perceived impact of injury on daily activities between individuals with chronic stroke who seek long-term supports in a community center and other individuals with chronic stroke (normative data).

BACKGROUND: Stroke leads to a wide array of physical, sensory, and psychosocial effects on functioning, leading to long-term challenges in participation in daily activities of affected individuals (D’Alisa, Baudo, Mauro, & Miscio, 2005). Evidence suggests that community-based rehabilitation services create positive outcomes for recovery and community integration of individuals with chronic stroke (Langstaff et al., 2014; McCabe et al., 2007; Walker, Sunnerhagen, & Fisher, 2013). Evaluating client-perceived performance and satisfaction provides insight into how community-based programs might be effective in supporting participation at home and in the community for individuals with stroke.

DESIGN AND METHOD: This study was a retrospective chart review of longitudinal data obtained from the American Stroke Foundation (ASF). Participants were 72 individuals with stroke, with the majority being male (61.1%), White (66.7%), and average age of 68 yr. Measures included (1) the Montreal Cognitive Assessment to assess cognitive function; (2) the Canadian Occupational Performance Measure to evaluate perceived performance and satisfaction; and (3) the Stroke Impact Scale (SIS) to determine self-perceived impact of injury. Deidentified data were entered into a secure REDCap (Nashville, TN) database. The data analysis plan included paired t tests to evaluate change in SIS scores over time; bivariate correlation analysis among sample demographics, cognitive function, and perceived performance and satisfaction; and independent t tests to compare SIS scores with normative data.

RESULTS: This study found a statistically significant increase on the Mobility domain subscore of the SIS (p = .017) after participating in the ASF program for 3.9 yr on average. The remaining seven domains were not significantly different on the SIS. The correlation analysis revealed a significant positive correlation between sex and perceived activity performance (r = .42, p = .022; n = 30) and a significant negative correlation between hypertension and satisfaction (r = –.52, p = .007; n = 25). Further analysis of the baseline performance scores revealed a significant difference between men and women, in which men had higher perceived performance scores compared with women (p = .022). The comparison of the SIS total scores of ASF clients with the normative data total scores showed no significant differences.

CONCLUSION: Men’s perception of their functional performance was higher than women’s at the time of joining the ASF program. Mobility was among the top performance problems reported by participants. Additionally, participants’ perceptions about their mobility improved after receiving community-based services, which included a group-based physical exercise program. Further, having comorbidities like hypertension was associated with decreased client satisfaction, perhaps because it limits individuals’ ability to participate in preferred activities.

IMPACT STATEMENT: In addition to acute management and timely rehabilitation services, it is imperative to also consider long-term supports that facilitate optimal independent functioning and quality of life for individuals during the chronic stage of their recovery from stroke. Community-based support programs like the ASF offer additional opportunities for participating in meaningful activities in a social context. This study demonstrates that being engaged in such programs offered gains in self-perceived activity performance.

References

D’Alisa, S., Baudo, S., Mauro, A., & Miscio, G. (2005). How does stroke restrict participation in long-term post-stroke survivors? Acta Neurologica Scandinavica, 112, 157–162. https://doi.org/10.1111/j.1600-0404.2005.00466.x

Langstaff, C., Martin, C., Brown, G., McGuinness, D., Mather, J., Loshaw, J., . . . Paterson, J. (2014). Enhancing community-based rehabilitation for stroke survivors: Creating a discharge link. Topics in Stroke Rehabilitation, 21, 510–519. https://doi.org/10.1310/tsr2106-510

McCabe, P., Lippert, C., Weiser, M., Hilditch, M., Hartridge, C., Villamere, J., & Erabi, G. (2007). Community reintegration following acquired brain injury. Brain Injury, 21, 231–257. https://doi.org/10.1080/02699050701201631

Walker, M. F., Sunnerhagen, K. S., & Fisher, R. J. (2013). Evidence-based community stroke rehabilitation. Stroke, 44, 293–297. https://doi.org/10.1161/STROKEAHA.111.639914