Abstract
Objective
To explore reciprocal effects between participation and emotional and physical well-being
during the first 2 years poststroke.
Design
Prospective cohort study.
Setting
Community.
Participants
An inception cohort of adults (N=67) who had been discharged from an acute stroke
unit or stroke rehabilitation unit after a first stroke.
Interventions
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.
Results
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.
Conclusions
Our results support a 2-pronged approach to addressing well-being poststroke where
efforts to improve affect and boost participation are simultaneously applied.
Keywords
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)To read this article in full you will need to make a payment
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References
- The impact of mild stroke on meaningful activity and life satisfaction.J Stroke Cerebrovasc Dis. 2006; 15: 151-157
- Managing an everyday life of uncertainty: a qualitative study of coping in persons with mild stroke.Disabil Rehabil. 2009; 31: 773-782
- Towards a greater understanding of the experience of stroke: integrating quantitative and qualitative methods.J Aging Stud. 2003; 17: 171-187
- The meaning of occupational gaps in everyday life in the first year after stroke.OTJR (Thorofare N J). 2010; 30: 184-192
- Fighting back—struggling to continue life and preserve the self following a stroke.Health Care Women Int. 2004; 25: 370-387
- “Getting back to real living”: a qualitative study of the process of community reintegration after stroke.Clin Rehabil. 2010; 24: 1045-1056
- The World Health Organisation's terminology and classification: application to severe disability.Disabil Rehabil. 2004; 26: 182-188
- A national survey of occupational therapists' practices related to participation post stroke.J Rehabil Med. 2008; 40: 291-297
- Bottom-up or top-down evaluation: is one better than the other?.Am J Occup Ther. 2004; 58: 594-599
- The role of positive affect on social participation following stroke.Disabil Rehabil. 2012; 34: 2119-2123
- Depression improvement is related to social role functioning after stroke.Arch Phys Med Rehabil. 2012; 93: 978-982
- Goal achievement in the six months after inpatient rehabilitation for stroke.Disabil Rehabil. 2009; 31: 880-886
- Determinants of participation restriction among community dwelling stroke survivors: a path analysis.BMC Neurol. 2009; 9: 49
- Outcomes after stroke: basic and instrumental activities of daily living, community reintegration and generic health status.Aust Occup Ther J. 2003; 50: 225-233
- The Functional Independence Measure: a new tool for rehabilitation.in: Eisenberg M.G. Grzesiak R.C. Advances in clinical rehabilitation. Springer, New York1987: 6-18
- Assessment of global function: the Reintegration to Normal Living Index.Arch Phys Med Rehabil. 1988; 69: 583-590
- Issues for selection of outcome measures in stroke rehabilitation: ICF participation.Disabil Rehabil. 2005; 27: 507-528
- An occupational perspective on the concept of participation in the International Classification of Functioning, Disability and Health—some critical remarks.Am J Occup Ther. 2005; 59: 569-576
- Validation of the Reintegration to Normal Living Index in a population of community-dwelling people with mobility limitations.Arch Phys Med Rehabil. 2005; 86: 344-345
- Reliability of scores between stroke patients and significant others on the Reintegration to Normal Living (RNL) Index.Disabil Rehabil. 2003; 25: 433-440
- There's no place like home: an evaluation of early supported discharge for stroke.Stroke. 2000; 31: 1016-1023
- Can stroke patients use visual analogue scales?.Stroke. 1999; 30: 1357-1361
McDowell I, Newell C. Measuring health: A guide to rating scales and questionnaires. New York: Oxford University Press; 1987. p 125-33.
- A concurrent validational study of the NCHS General Well-Being Schedule.U.S. Department of Health Education and Welfare, National Centre for Health Statistics, Hyattsville1977 (Report No. 78-1347)
- Predicting mortality and healthcare utilization with a single question.Health Serv Res. 2005; 40: 1234-1246
- Self-rated health and mortality: a review of twenty-seven community studies.J Health Soc Behav. 1997; 38: 21-37
- An introduction to applying individual growth curve models to evaluate change in rehabilitation: a National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems report.Arch Phys Med Rehabil. 2013; 94: 589-596
- Longitudinal analysis of quality of life for stroke survivors using latent curve models.Stroke. 2008; 39: 2795-2802
- Hierarchical linear models: applications and data analysis methods.2nd ed. Sage, Newbury Park2002
- HLM 7: hierarchical linear and nonlinear modeling.Scientific Software International, Lincolnwood2011
- A test of missing completely at random for multivariate data with missing values.J Am Stat Assoc. 1988; 83: 1198-1202
- Multilevel analysis: techniques and applications.2nd ed. Routledge, New York2010
- Effective coping with stroke disability in a community setting: the development of a causal model.J Neurosci Nurs. 1994; 26: 193-203
- A longitudinal view of apathy and its impact after stroke.Stroke. 2009; 40: 3299-3307
- The activity restriction model of depressed affect.in: Williamson G.M. Shaffer D.R. Parmelee P.A. Physical illness and depression in older adults. Kluver Academics/Plenum Publishers, New York2000: 173-200
- The role of activity restriction in poststroke depressive symptoms.Rehabil Psychol. 2009; 54: 315-322
- Interventions for treating depression after stroke.Cochrane Database Syst Rev. 2008; : CD003437
- A lifestyle intervention as supplement to a physical activity programme in rehabilitation after stroke: a randomized controlled trial.Clin Rehabil. 2012; 26: 502-512
- Are rehabilitation and/or care co-ordination interventions delivered in the community effective in reducing depression, facilitating participation and improving quality of life after stroke?.Disabil Rehabil. 2011; 33: 1501-1520
- Occupational therapy for stroke patients: a systematic review.Stroke. 2003; 34: 676-687
- Inter-task transfer of meaningful, functional skills following a cognitive-based treatment: results of three multiple baseline design experiments in adults with chronic stroke.Neuropsychol Rehabil. 2010; 20: 541-561
- Pilot randomized controlled trial investigating cognitive strategy use to improve goal performance after stroke.Am J Occup Ther. 2012; 66: 104-109
- Fulfilling the promise: supporting participation in daily life.Arch Phys Med Rehabil. 2011; 92: 169-175
- Down with the class society [editorial]!.Stroke. 2003; 34: 2628-2629
- Socioeconomic differences in stroke incidence and prognosis under a universal healthcare system.Stroke. 2008; 40: 2812-2819
- Effect of socioeconomic status on treatment and mortality after stroke.Stroke. 2002; 33: 268-275
- Study of the relationship between social deprivation and outcome after stroke.Stroke. 2005; 36: 815-819
- Quality of life declines after first ischemic stroke: the Northern Manhattan Study.Neurology. 2010; 75: 328-334
- Activity, participation and quality of life 6 months post stroke.Arch Phys Med Rehabil. 2002; 83: 1035-1042
- Handicap after stroke: how does it relate to disability, perception of recovery, and stroke subtype? The North East Melbourne Stroke Incidence Study (NEMESIS).Stroke. 2002; 33: 762-768
- Age at stroke: temporal trends in stroke incidence in a large, biracial population.Neurology. 2012; 79: 1781-1787
- Changing face of stroke: implications for occupational therapy practice.Am J Occup Ther. 2009; 63: 621-625
Article info
Publication history
Published online: September 03, 2013
Footnotes
Supported by the Heart and Stroke Foundation of Ontario (grant no. NA 6743) and the Ontario Stroke System (grant no. F08-765).
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
