Self-Reported Emotional Health and Social Support but not Executive Function Predict Participation After Mild Stroke

Mild stroke survivors’ needs for successful community reintegration and resuming quality lives have long been neglected in stroke rehabilitation. Where rehabilitation tends to focus on restoring self-care independence (Fride et al, 2015), 65% of stroke survivors persistently struggle in returning to pre-stroke social roles and other meaningful or necessary occupations (Bertolin et al., 2018). For occupational therapists, this should be a call to action to identify and address barriers to occupational participation to empower individuals with mild stroke to lead enriching lives. Executive function (EF), or higher-level thinking processes necessary for goal-oriented tasks (Chung et al, 2013), and emotional health are often negatively impacted by neurological and life-altering stroke effects (Fride et al., 2015). Lower social support is also often reported after stroke (Della Vecchia et al., 2018). These factors have been independently associated with post-stroke participation restrictions (Della Vecchia et al., 2018; Fride et al., 2015). This study aimed to fill a gap in the literature by understanding the relative significance of EF, emotional health, and social support as they predict participation. A secondary aim was to understand how factors similarly or differentially predict mild stroke outcomes across different participation measures. Cross-sectional, quantitative data from 114 community-dwelling, mild stroke survivors, including those ≥6 months after first-ever, mild stroke with and without aphasia, was collected for analysis. Our sample was reasonably representative of different demographic characteristics: self-identified gender (63 female, 51 male), self-identified race (59 Caucasian, 53 African American, 1 Asian, 1 Hispanic/Latinx), and aphasia status (58 persons with aphasia). Despite having only mild stroke severity and being an average of ∼3 years post stroke, participation restrictions for our sample were contrastingly profound. On average, participants reported a 30% loss of pre-stroke activities; activity restrictions occurring at a rate of 30% of the time; and expressed being only moderately satisfied with their ability to reintegrate into the community. No significant differences were found between groups with and without aphasia. Significant correlates (self-reported emotional health, available social support, executive functioning, education level, and stroke severity) accounted for 26.4%-40.2% of the variance across participation outcome measures. Emotional health was consistently a significant predictor across participation outcomes. Social support was only a predictor of participation when defined specifically through constructs of participation satisfaction and quality. Executive functioning was surprisingly not a significant predictor. In conclusion, occupational therapists should employ interventions that effectively improve post-stroke emotional health and social support, as modifiable factors, to optimize meaningful participation and quality of life. Further research is necessary to understand the relative significance of facilitating or restricting factors on participation for mild stroke survivors to support targeted, and evidence-based interventions within the scope of occupational therapy. We need to continue to expand our understanding of participation to reinforce participation as a primary measurement of success and as an integral piece of our professional foundations.

References

Bertolin, M., Van Patten, R., Greif, T., & Fucetola, R. (2018). Predicting cognitive functioning, activities of daily living, and participation 6 months after mild to moderate stroke. Archives of Clinical Neuropsychology, 33(5), 562-576. https://doi.org/10.1093/arclin/acx108

Chung, C. S. Y., Pollock, A., Campbell, T., Durward, B. R., & Hagen, S. (2013). Cognitive rehabilitation for executive function problems after brain injury. Cochrane. https://www.cochrane.org/CD008391/STROKE_cognitive-rehabilitation-for-executive-function-problems-after-brain-injury

Fride, Y., Adamit, T., Maeir, A., Assayag, E. B., Bornstein, N. M., Korczyn, A. D., & Katz, N. (2015). What are the correlates of cognition and participation to return to work after first ever mild stroke? Topics in Stroke Rehabilitation, 22(5), 317-225. https://doi.org/10.1179/1074935714Z.0000000013

Della Vecchia, C., Préau, M., Dima, A., Viprey, M., Haesebaert, J., & Schott, A.-M. (2018). Environmental determinants of participation restriction after stroke: A systematic review of observational and qualitative studies. Revue d’Epidemiologie et de Santé Publique, 66(Supplement 5), S343-S343. https://doi.org/10.1016/j.respe.2018.05.286