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Short-Term Changes in and Predictors of Participation of Older Adults After Stroke Following Acute Care or Rehabilitation

Research Center on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Department of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, johanne.desrosiers{at}USherbrooke.ca

Louise Demers, PhD

Research Centre, University Institute of Geriatrics of Montreal, Montréal

Line Robichaud, PhD

School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal

Claude Vincent, PhD

Department of Rehabilitation, Université Laval, Quebec City, Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City

Sylvie Belleville, PhD

Department of Psychology, Faculty of Arts and Sciences, Université de Montréal

Bernadette Ska, PhD

School of Speech Therapy and Audiology, Faculty of Medicine, Université de Montréal Quebec, Canada

Background. Stroke can lead to restrictions in participation in daily activities and social roles. Although considered an important rehabilitation outcome, little is known about participation after stroke and its predictors, and about the differences associated with the types of services provided following stroke. Objective . The aims of this study were 1) to follow and compare changes in participation of older adults discharged home after stroke from acute care or postacute rehabilitation, and 2) to identify the best predictors of participation after stroke from physical, cognitive, perceptual, and psychological ability measures taken shortly after discharge. Methods. Level of participation in daily activities and social roles of 197 older adults who had a stroke was evaluated at 2 to 3 weeks (T1), 3 months (T2), and 6 months (T3) after being discharged home from acute care (n = 86) or rehabilitation (n = 111). Physical, cognitive, perceptual, and psychological abilities were assessed at T1. Results. A significant increase in participation was found over time for both groups, mainly in the first 3 months. The best predictors of participation differed between the groups and between the daily activities and social roles domains. Walking and acceptance of the stroke or fewer depressive symptoms were the best predictors of the level of participation after stroke. Conclusions . Participation was not optimal at discharge because it continued to increase after the return home. The importance of psychological factors in participation after stroke is undeniable. Many predictors are amenable to interventions.

Key Words: Stroke rehabilitation • Neurological score • Cognitive functions • Affect (depressive symptoms)

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