Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
The purpose of this study is to investigate the extent to which cognitive ability and emotional health predict social participation poststroke for people with and without aphasia. Apathy was found to be an independent predictor of social participation. The results of this study indicate that apathy ought to be further investigated as its own, stand-alone predictor of social participation among the population with stroke and should be recognized and addressed in rehabilitation.
Primary Author and Speaker: Laura Magee
Contributing Authors: Laura Magee, Marjorie Nicholas, and Lisa Connor
PURPOSE: The purpose of this study is to investigate the extent to which cognitive ability and emotional health predict social participation post stroke for people with (PWA) and without (PWOA) aphasia. Stroke is the leading cause of disability in the United States and may result in cognitive dysfunction, depression, and apathy (American Stroke Association, 2016). Although social participation is a known, significant contributor to quality of life, its relationship with emotional health and cognition, together, post-stroke, has not been explored (Almborg et al., 2010). This study also utilized aphasia adapted techniques to purposefully include people with aphasia, who make up 25-40% of stroke survivors and are historically excluded from stroke research (National Aphasia Association, 2016).
DESIGN: This is a cross-sectional, correlational, quantitative study aimed to explore the relationship between cognitive ability, depression, apathy, and social participation.
METHODS: PWA and PWOA who were at least six months post-stroke were recruited from local, community support groups. Participants who met the inclusion criteria, including only one stroke, lack of pre-existing, chronic health conditions, and ability to reliably answer yes and no questions, participated in an assessment battery over 2, 3-hour long sessions. Depression, apathy, cognitive ability, and social participation were measured, respectively, by the Patient Health Questionnaire 9 (PHQ-9), the Apathy Evaluation Scale (AES), the trail-making subtest of the Delis Kaplan Executive Functions System (DKEFS), and the social participation subtest of the Activity Card Sort (ACS). Analysis included an independent samples t-test, Pearson correlations, and hierarchical multiple regression.
RESULTS: A total of 78 individuals (n = 78) participated in this study (39 females, 39 males). There were 45 PWA and 33 PWOA. No significant difference in percent of social activity retained, as measured by the ACS Social Domain Percent Retained, was found between PWA and PWOA. Pearson correlations revealed that the presumed factors of cognition, apathy, and depression were all correlated (p < 0.10) with the social participation outcome measure. Multiple regression analysis found that 21% of variance of social participation was explained by all predictive variables (R
2 = .207). Apathy was found to be the only independent predictor of ACS Social Domain Percent Retained (p = .007). Neither depression (p = .378) nor cognition (p = .269) were independent predictors.
CONCLUSION: Collectively depression, apathy, and cognitive ability accounted for 21% of the variance in social participation. While this is significant, there is still an unaccounted variance of 79%, indicating that social participation is complex and influenced by other variables. Perhaps the most significant finding of this study was that apathy is a strong, independent predictor of social participation. This result is supported by newer literature that indicates minor apathy by itself is strongly, negatively correlated with general participation (Mayo, 2009). The results of this study indicate that apathy ought to be further investigated as its own, stand-alone predictor of social participation amongst the stroke population and should be recognized and addressed in rehabilitation.
References
American Stroke Association. (2016). Impact of stroke. Retrieved from https://www.strokeassociation.org/STROKEORG/AboutStroke/Impact-of-Stroke-Stroke-statistics_UCM_310728_Article.jsp
Almborg, A. H., Ulander, K., Thulin, A., & Berg, S. (2010). Discharged after stroke – important factors for health-related quality of life. Journal of Clinical Nursing, 19, 2196–2206. https://doi.org/10.1111/j.1365-2702.2010.03251.x
National Aphasia Association. (2016). Aphasia FAQs. Retrieved from https://www.aphasia.org/aphasia-resources/aphasia-factsheet/
Mayo, N., Fellows, L. K., Phil, D., Scott, S. C., Cameron, J., Wood-Dauphinee, S. (2009). Longitudinal view of apathy and its impact after stroke. Stroke. https://doi.org/10.1161/STROKEAHA.109.554410
