Original article| Volume 96, ISSUE 3, P456-463, March 2015

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Does the Frequency of Participation Change After Stroke and Is This Change Associated With the Subjective Experience of Participation?

  • Anne-Marije V. Blömer
    Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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  • Maria L. van Mierlo
    Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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  • Johanna M. Visser-Meily
    Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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  • Caroline M. van Heugten
    Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands

    Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
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  • Marcel W. Post
    Corresponding author Marcel W. Post, PhD, Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, De Hoogstraat Rehabilitation, Rembrandtkade 35, 3583 TM, Utrecht, The Netherlands.
    Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands

    Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Published:September 25, 2014DOI:



      To investigate changes in the frequency of participation 6 months poststroke compared with prestroke; and to establish whether the change is associated with participation restrictions and satisfaction with participation 6 months poststroke.


      Inception cohort study. Prestroke frequency of participation was measured retrospectively in the first week poststroke. Frequency, participation restrictions, and satisfaction with participation were assessed 6 months poststroke.


      General hospitals and home residences.


      Patients with stroke (N=325; 65.5% men; mean age, 66.9±12.2y) admitted to 1 of 6 participating general hospitals.


      Not applicable.

      Main Outcome Measure

      Utrecht Scale for Evaluation of Rehabilitation-Participation (0–100), which consists of 3 scales: frequency, restrictions, and satisfaction. The frequency scale consists of 2 parts: vocational activities (work, volunteer work, education, household activities) and leisure and social activities.


      Vocational activities showed a large decrease (effect size: 0.6) poststroke; leisure and social activities showed a small decrease (effect size: 0.13) poststroke. In multiple regression analyses, both the frequency of participation in vocational activities 6 months poststroke and the decrease in vocational activities compared with before the stroke were significantly associated with the participation restrictions experienced and satisfaction with participation after controlling for age, sex, level of education, dependency in activities of daily living, cognitive functioning, and presence of depressive symptoms. The presence of depressive symptoms showed the strongest association with the subjective experience of participation.


      The frequency of participation decreased after a stroke, and this decrease was associated with participation restrictions experienced and satisfaction with participation. Resuming vocational activities and screening and, if applicable, treatment of depressive symptoms should be priorities in stroke rehabilitation.


      List of abbreviations:

      ADL (activities of daily living), BI (Barthel Index), ICF (International Classification of Functioning, Disability and Health), USER-Participation (Utrecht Scale for Evaluation of Rehabilitation-Participation)
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