Social Support Mediates the Relationship Between Communication Abilities and Social Participation Post-Stroke Only for People With Aphasia (PWA)

This study examines the extent to which social support effects the relationship between communication abilities and social participation for individuals 6 months or more post-stroke, with aphasia (PWA) or without (PWOA). Current literature shows there is a positive influence of social support on social participation (Foley et al., 2018; Hilari & Northcott, 2006). Evidence also shows that social support impacts the amount of communication a person with aphasia (PWA) engages in (Eadie et al., 2018; Dalemans et al., 2010). There is no literature exploring whether social support serves a different role for PWA and PWOA in social participation. We hypothesized that the relationship between communication and social participation is mediated by social support for PWA, but not for PWOA. A quasi-experimental, cross-sectional design investigated the relationships among social support, communication, and social participation using self-perception measures.

INCLUSION CRITERIA: age 18 years or older, 6 months or greater post-stroke, mobile enough to come to testing site, and able to tolerate two sessions of three-hours each.

EXCLUSION CRITERIA: history of additional strokes, traumatic brain injury, pre-stroke disability, other existing neurological conditions, history of seizures, and history of mental health issues that are not well-controlled. Participants (n=118) completed the Medical Outcomes Study Social Support Survey, Stroke Impact Scale communication domain, and Activity Card Sort social domain. These assessments measured self-perceived: amount of social support, degree of communication impairment, and percent retained participation in social activities, respectively. Independent samples t-tests compared differences between PWA and PWOA. Pearson correlations were performed among social support, communication, and social participation. Partial correlations were completed, controlling for social support and observing the effect on the correlation between communication and social participation. Results showed that PWA and PWOA did not differ on their self-perception of social support and social participation. Perceived communication was greater for PWOA than PWA. All Pearson correlations were significant, except for the correlation between communication abilities and social participation in PWOA. The partial correlation between communication and social participation in PWA was not significant, when controlling for social support. Although the amount of social participation did not differ between PWA and PWOA, influences on participation differed for the two groups. For PWA only, there was a significant relationship between communication and social participation that was mediated by perceived social support. These results may have an impact on the way that occupational therapists view their discharge planning after rehabilitation, taking into consideration social supports to maximize community reintegration for people with aphasia.

References

Foley, E. L., Nicholas, M. L., Baum, C. M., & Connor, L. T. (2018). Influence of environmental factors post-stroke. Behavioural Neurology, 1-8.

Hilari, K., Northcott, S. (2006). Social support in people with chronic aphasia. Aphasiology, 20(1), 17-36.

Eadie, T., Kapsner-Smith, M., Bolt, S., Sauder, C., Yorkston, K., & Baylor, C. (2018). Relationship between perceived social support and patient-reported communication outcomes across communication disorders: A systematic review. International Journal of Language and Communication Disorders, 53(6), 1059-1077.

Dalemans, R. J. P., de Witte, L. P., Beurskens, A. J. H. M., Van Den Heuvel, W. J. A., & Wade, D. T. (2010). An investigation into the social participation of stroke survivors with aphasia. Disability and Rehabilitation, 32(10), 1678-1685.