Discharge outcomes as predictors of social participation in the community after a stroke: a cohort study

The mapping of possible predictors of restrictions in the social participation of people after stroke in the community can be an essential tool to support the development of rehabilitation strategies even in the hospital environment. This study aimed to identify whether mobility, functional balance and dependence on functionality at hospital discharge can predict restrictions on social participation 1 year after stroke in the community. This is a hospital-based cohort study, with individuals over 18 years old admitted with a diagnosis of acute stroke included. People with dementia, previous functional limitations and cancer patients were omitted. Mobility, balance and functional independence were the predictor variables at hospital discharge, and the outcome of interest was social participation assessed 1 year after a stroke in the community. Forty-eight patients were included after a 1-year follow-up. The degree of functional independence at hospital discharge ( β  = 0.813; P  < 0.01) was the independent predictor of social participation, specifically the locomotion ( β  = 0.452; P  < 0.001) and social cognition ( β  = 0.462; P  < 0.001) related to functional independence. Mobility ( β  = 0.040; P  = 0.777) and functional balance ( β  = 0.060; P  = 0.652) did not show an independent association. Cognitive functional independence was a predictor of daily activities ( β  = 0.786; P  < 0.001), social roles ( β  = 0.390; P  = 0.014) and satisfaction ( β  = 0.564; P  < 0.001) of social participation. The degree of functional independence of people after a stroke at hospital discharge was able to predict the level of social involvement in the community one year after the stroke.

Body structure/function impairments and activity limitations of post-stroke that predict social participation: a systematic review

BACKGROUND

Stroke is the leading cause of death and disability in Brazil, and its prognostic indicators of social reintegration are not well established yet.

OBJECTIVE

To identify body structure/function impairments and activity limitations in post-stroke that predict social participation restrictions in the community.

METHODS

cohort studies were selected, involving adult post-stroke participants, which investigated body structure and function impairments or activity limitations of post-stroke individuals as predictors of social participation in the community. Studies that included individuals with subarachnoid hemorrhage, other neurological disorders and participants in long-term care facilities were excluded. The Newcastle-Ottawa quality assessment scale was applied to assess the methodological quality. The results were synthesized according to the found exposures, considering the used statistical models.

RESULTS

Eleven articles were included, with a total of 2,412 individuals, 58.4% men, 83.7% ischemic stroke. Seven exposures were assessed across studies, in which 10 studies assessed body structure and function exposures (stroke severity, cognitive, executive, emotional and motor function), and 8 studies assessed activity exposures (daily living activity and walking ability).

CONCLUSION

There is some evidence that stroke severity, mental and motor deficits, limitations in activities of daily living and the ability to walk after a stroke can predict social participation in the community. PROSPERO registration CRD42020177591.