From Hospital to Community: Longitudinal Changes of Participation in Younger Stroke Survivors

The incidence of stroke age younger than 65 years has been growing rapidly in the past decade. While participating in society is an ultimate rehabilitation goal for younger stroke survivors, there is dearth of understanding about the course of participation changes and the determinants of the changes during and following rehabilitation. In Taiwan, outpatient rehabilitation programs primarily target on enhancing patients’ activity performance (e.g., mobility and self-care). Some programs incorporate social support components into the interventions. However, the mechanism of whether and how activities and social support affect participation changes in younger stroke survivors is unknown. The primary aim of this study is to advance knowledge about longitudinal changes of participation in productivity, social, and community domains among stroke survivors younger than 65 years during a 1-year post-hospitalization rehabilitation. The secondary aim of the study is to examine the interrelations between the changes of activity performance, social support and participation. A longitudinal study will be conducted in stroke patients (N=400) aged 20-64 years who are receiving outpatient rehabilitation in the greater Taipei area. The assessments will be conducted at baseline and 3-, 6-, and 12-months follow-ups. At each assessment, participation will be assessed via personal interviews using the Participation Measure (PM), which includes three participation domains: productivity, social, and community. Activity performance, social support and information on personal factors such as demographics and clinical variables will be collected through standardized assessment tools, questionnaires, and medical chart review. The collected data will be analyzed using mixed-effects regression modeling and structural equation modeling (SEM). The findings of this study will lead to an improved understanding of the recovery trajectory of participation in younger stroke survivors receiving outpatient rehabilitation and the potential impact from activities and social support on the changes of participation. Results will provide insight into the effectiveness of current rehabilitation services in Taiwan and the potential need for modifications to improve participation outcomes in the younger stroke population.