Original article| Volume 95, ISSUE 2, P262-268, February 2014

Participation and Well-Being Poststroke: Evidence of Reciprocal Effects

Published:September 03, 2013DOI:



      To explore reciprocal effects between participation and emotional and physical well-being during the first 2 years poststroke.


      Prospective cohort study.




      An inception cohort of adults (N=67) who had been discharged from an acute stroke unit or stroke rehabilitation unit after a first stroke.


      Not applicable.

      Main Outcome Measures

      Participation (Reintegration to Normal Living Index), emotional well-being (General Well-being Schedule), and physical well-being (General Self-rating of Health Question) were measured at 6, 9, 12, 18, and 24 months poststroke. Hierarchical linear modeling was used to examine the association between participation and change in well-being, controlling for sex, age, impairment (discharge FIM), and median neighborhood income.


      Greater engagement in valued activities was significantly associated with subsequent improvement in emotional well-being. The effect of participation on change in physical well-being was marginal. Higher levels of well-being also predicted subsequent increases in participation, with emotional well-being effects moderated by income, and physical well-being effects moderated by level of impairment.


      Our results support a 2-pronged approach to addressing well-being poststroke where efforts to improve affect and boost participation are simultaneously applied.


      List of abbreviations:

      GHQ (General Self-rating of Health Question), GWB (General Well-being Schedule), ICC (intraclass correlation coefficient), ICF (International Classification of Functioning, Disability and Health), RNLI (Reintegration to Normal Living Index)
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