Influence of Environmental Factors on Social Participation Poststroke

This study examined the extent to which environmental factors affected participation in social activities, as identified on the Activity Card Sort (ACS: Baum & Edwards, 2008), for individuals at least 6 months post-stroke with and without aphasia. Social participation is important to consider as it is the hallmark of what society perceives as functioning. Individuals who have had a stroke often experience a loss of social opportunities, changes in their relationships, and social isolation (Woodman et al., 2014). Previous research indicates that the environment can support or hinder participation as much, or more than, impairment. However, there remains a general lack of understanding about the relationship between participation and environment, specifically for social participation. To address this gap, a quasi-experimental, cross-sectional design characterized the relationship between environmental factors and social participation. Inclusion criteria: age ≥ 18 years, ≥ 6 months post-stroke, able to tolerate two-three hours of testing, and mobile enough to travel to the testing site. Exclusion criteria: history of additional strokes after the index stroke, traumatic brain injury, on-going seizure disorder, pre-stroke disability, pre-existing neurological condition, or severe medical or psychiatric illness. Participants (n=49) completed measures of participation (ACS), environment (Measure of Stroke Environment (MOSE), Medical Outcome Study Social Support (MOS), Stroke Impact Scale), stroke severity (NIH Stroke Scale), and severity of aphasia (Boston Diagnostic Aphasia Examination). The outcome measure, social participation, was conceptualized in two ways: 1) the ACS Social Domain percent retained score and 2) the calculated percent retained for items that were ranked high on the task demand of needing ‘a partner to do activity with’ by an independent sample of 43 individuals (Austin et al., 2013). Using significantly correlated items as predictors, two multiple regression analyses were conducted. Results revealed that 37.2% of the variance in ACS Social Domain and 34.9% of the variance in ACS Partner to Do With were explained by MOS Social Support Positive Social Interactions, SIS Mobility, MOSE Receptivity, and MOSE Built Environment. MOS Social Support Positive Social Interactions was the only independent predictor for either measure of social participation. Several environmental factors influence social participation, but the strongest predictor of social participation after stroke is how often an individual has someone else to do something enjoyable with. Thus, individuals may be able to participate in meaningful social activities if they have supportive social relationships, regardless of other environmental barriers. This study provides occupational therapists with a better understanding of important environmental factors to consider when addressing social participation after stroke. More broadly, this study helps to expand the focus of the rehabilitation literature beyond body functions and structures to participation in meaningful activities.

References

Austin, C., Connor, L.T., Mandoske, V., & Fox, K. (2013). Clarifying activity dimensions within the activity card sort to enhance measurement of participation. Unpublished manuscript.

Baum, C. M., & Edwards, D. (2008). Activity Card Sort (2nd, Edition). Bethesda, MD: American Occupational Therapy Association.

Woodman, P., Riazi, A., Pereira, C., & Jones, F. (2014). Social participation post stroke: A meta ethnographic review of the experiences and views of community-dwelling stroke survivors. Disability and Rehabilitation, 36(24), 2013-2043. doi: 10.3109/09638288.2014.887796