Abstract
Objective
To investigate the content and effectiveness of interventions that address poststroke
community participation.
Data Sources
EMBASE, PsycINFO, PubMed, and Cumulative Index to Nursing and Allied Health (CINAHL)
were searched using 3 indexing terms and respective thesaurus: stroke, social participation,
and clinical trials. Filters for English, publication dates (January 2001-May 2017),
and publication types were used. The search also included checking references from
relevant systematic reviews.
Study Selection
Studies conducted with adults with stroke, evaluating interventions addressing community
participation, having a comparison group, and reporting at least 1 of 3 outcomes (participation,
depression, and health-related quality of life) were selected. Retrieved articles
were screened by 2 reviewers. After substantial agreement was achieved using interrater
reliability, reviewers screened articles independently. Eighteen of 1130 articles
were included.
Data Extraction
Characteristics of participants, key elements of intervention, comparator, and results
were independently extracted by 2 reviewers. Intervention content was categorized
based on 9 categories from the International Classification of Functioning, Disability,
and Health Activities and Participation domains. Risk of selection, performance, attrition,
and reporting bias were evaluated.
Data Synthesis
Two intervention categories were identified: leisure participation and community integration.
Three leisure and 4 community integration interventions showed significant group differences
favoring the intervention group in the target outcomes. The majority of interventions
addressed the leisure, interpersonal relations, and community life categories of International
Classification of Functioning, Disability, and Health with few focusing on political
life, education, assisting others, and religion.
Conclusions
A limited number of studies showed an effect on participation, depression, and health-related
quality of life outcomes. There were gaps in intervention content indicating that
current community participation interventions fall short in addressing full inclusion
and citizenship of people with stroke. Future interventions should focus on civic-
and societal-level participation and community activities beyond leisure.
Keywords
List of abbreviations:
ADL (activities of daily living), HRQoL (health-related quality of life), ICF (International Classification of Functioning, Disability, and Health), RCT (randomized controlled trial), SF-36 (36-item Short Form Health Survey), SIS (Stroke Impact Scale)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 20, 2019
Footnotes
The paper was partially prepared while the first author was a postdoctoral fellow in the Advanced Rehabilitation Research Training program funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (grant no. 90AR5019).
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
