Participation and Its Association With Health Among Community-Dwelling Adults With Chronic Stroke

Importance: Little is known about the severity of participation restrictions among people living in the community with chronic stroke. Even less is known about the association between participation and health in this population. Objective: To describe participation among people with chronic stroke and examine the association between participation and physical and mental health. Design: Secondary analysis of baseline data from an intervention study. Setting: The parent multisite intervention study was conducted in the community, and assessments were administered in participants’ homes. Participants: Thirty-one community-dwelling adults with chronic stroke. Outcomes and Measures: Participation was measured with the Activity Card Sort (percentage of prestroke activities retained) and the Enfranchisement Scale of the Community Participation Indicators. Health was measured with the PROMIS^®–29 Physical Health and Mental Health subscales. We calculated descriptive statistics for participation measures and Spearman’s r correlations between participation and health outcomes. Results: Participation scores were poor on all measures of participation. Most striking, 94.9% of participants retained less than 80% of their prestroke activities. All measures of participation were modestly correlated with physical health (r 5 .28–.46) and were moderately correlated with mental health (r 5 .42–.63). Conclusions and Relevance: Participation restrictions are prevalent among adults with chronic stroke, with potential implications for mental health. Stronger community-based rehabilitation and support services to enhance participation of this high-risk population are warranted. What This Article Adds: This report highlights the severity of participation restrictions among people with chronic stroke. Moreover, this report shows that people with stroke feel a lack of inclusion in the community and that participation is associated with mental and physical health.