Date Presented 04/21/21
This research explores the correlations between fatigue, apathy, and activities of daily living (ADLs) and instrumental activities of daily living (IADLs) participation with social participation after chronic stroke for persons with and without aphasia. Combined, these factors significantly relate to social participation, which emphasizes the complex nature of social participation. The implications of the moderate mediation effects of perceived ADL and IADL participation on the relationships between fatigue and apathy and social participation is discussed.
Primary Author and Speaker: Anna Hausermann
Additional Authors and Speakers: Orley Templeton, Jennifer Rugletic Washko, Carolyn Maguire, Erin Onoshko, Katherine Schmitter, Martina Sledziewski, and Michael Floren
Contributing Authors: Casey Beichler, Kristen Skoff, Kristin Kern, Michelle Marchetti, and Krista A. Pasko
PURPOSE: The purpose of this study was to analyze the associations among predictor variables (fatigue, apathy, and activities of daily living (ADL)/instrumental activities of daily living (IADL) participation) on perceived social participation in persons with aphasia (PWA) and without aphasia (PWOA) post stroke. Research demonstrates PWA and PWOA do not always return to their prior level of participation post stroke (Eriksson et al., 2013) and is inconsistent regarding the impacts of aphasia (Foley, 2018). Post stroke fatigue (PSF) and post stroke apathy (PSA) are noted in at least one-third of persons post stroke and both are negatively correlated with quality of life and ADL/IADL abilities (Carpenter et al., 2007; Chen et al., 2015). Therefore, the extent to which ADL/IADL participation mediates the relationship between fatigue and social participation and the relationship between apathy and social participation was examined.
DESIGN: This study utilized a quasi-experimental and cross-sectional design. Recruitment was performed via local support groups and rehabilitation centers and included those at least 6 months post singular stroke without the presence of any non-stroke related neurological symptoms.
METHODS: Participants (n = 66) completed the Multidimensional Assessment of Fatigue, the Apathy Evaluation Scale, the Activities domain of the Stroke Impact Scale, and the social participation domain from the Activity Card Sort. First, independent t-tests to determine between group differences for PWA and PWOA were performed. Second, Pearson correlations between predictor and outcome variables determined the magnitude of correlation. Third, multiple regressions calculated the percent variance of social participation accounted for by the predictor variables. Lastly, partial correlations were conducted to determine the mediation effects of ADL/IADL participation on fatigue and social participation and apathy and social participation.
RESULTS: Overall, participants reported a decline in pre-stroke participation of at least 20%; PWA did not report significantly greater loss in social participation than PWOA. All predictor variables were significantly correlated with social participation (p < .001), but none were found to be independent predictors. The combination of fatigue, apathy, and perceived ADL/IADL abilities accounted for 27% of the variance in social participation. Partial correlation revealed that self-perception of ADL/IADL participation reduced the correlation between fatigue and social participation and by 33% and apathy and social participation by 39%.
CONCLUSION: Social participation is a multidimensional occupation consistently restricted post stroke and therefore needs to be a focus in rehabilitation. The associations of fatigue, apathy, and ADL/IADL participation with social participation were significant and may be used to develop evidence-based interventions to target social participation. ADL/IADL participation mediated the relationships of fatigue and apathy with social participation to a moderate degree, supporting rehabilitation in this area to improve daily function and potentially counteract the negative relationships between fatigue and apathy and social participation. Clearly, however, more needs to be understood with regard to social participation as our models accounted for a modest proportion of the variance in social participation.
References
Carpenter, B. D., Edwards, E. F., Pickard, J. G., Palmer, J. L., Stark, S., Neufeld, P. S., & Morris, J. C. (2007). Anticipating relocation. Journal of Gerontological Social Work, 49(1-2), 165-184. https://doi.org/10.1300/J083v49n01_10
Chen, Y.K., Qu, J.F., Xaio, W. M., Li, W. Y., Weng, H. Y., Li, W., & Xaing, Y. T. (2015). Poststroke fatigue: Risk factors and its effect on functional status and health-related quality of life. International Journal of Stroke, 10(5), 506-512. https://doi.org/10.1111/ijs.12409
Eriksson, G., Baum, C. M., Wolf, T. J., & Connor, L. T. (2013). Perceived participation after stroke: The influence of activity retention, reintegration, and perceived recovery. American Journal of Occupational Therapy, 67, e131-e138. https://doi.org/10.5014/ajot.2013.008292
Foley, E. L., Nicholas, M. L., Baum, C. M., Connor, C. T. (2018). Influence of environmental factors on social participation post-stroke. Behavioral Neurology, 2019. https://doi.org/10.1155/2019/260639
