Journal of Rehabilitation Medicine 51-3 | Page 14

J Rehabil Med 2019; 51: 160–166 ORIGINAL REPORT FACTORS AFFECTING OUTCOME IN PARTICIPATION ONE YEAR AFTER STROKE: A SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL Martha GUSTAVSSON, MSc 1 , Susanne GUIDETTI, PhD 1 , Gunilla ERIKSSON, PhD 1,2 , Lena VON KOCH, PhD 1,3 and Charlotte YTTERBERG, PhD 4,5 From the 1 Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, 2 Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, 3 Theme Neuro, Karolinska University Hospital, Stockholm, 4 Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge and 5 Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Huddinge, Sweden Objective: To explore the importance of client cha­ racteristics (age, sex, stroke severity and participa­ tion before stroke), rehabilitation context (in-patient or client’s home) and approach (enhanced client- centeredness or not) on participation in every­ day life after stroke. Methods: A secondary analysis of data on 237 parti­ cipants from a previous randomized controlled trial evaluating an enhanced client-centred intervention after stroke. Plausible associations between client characteristics, context and rehabilitation approach, and a positive outcome regarding participation were explored. Three different outcome measures for par­ ticipation were used: Stroke Impact Scale 3.0, do­ main participation; Frenchay Activities Index; and Occupational Gaps Questionnaire. Results: For all participants there was a significant association between mild stroke and a positive out­ come using the Frenchay Activities Index. Among participants who had not received the enhanced client-centred approach, there was a significant as­ sociation between mild stroke and a positive out­ come using the Stroke Impact Scale. The context of rehabilitation, i.e. receiving home rehabilitation, was also associated with a positive outcome in the Frenchay Activities Index for the control group. Conclusion: In order to increase participation in every­ day life for people after stroke it appears to be important to use an enhanced client-centred ap­ proach, particularly when working within in-patient rehabilitation and with people with moderate or se­ vere stroke. Key words: stroke rehabilitation; activities of daily living; oc- cupational therapy; brain injury; logistic regression; client- centredness. Accepted Jan 22, 2019; Epub ahead of print Feb 27, 2019 J Rehabil Med 2019; 51: 160–166 Correspondence address: Martha Gustavsson, Alfred Nobels Allé 23, 141 83 Huddinge, Sweden. E-mail: [email protected] A stroke may impact a person on many different levels, and returning to life as it was before stroke can be a long-term struggle (1). For many years after stroke, the physical, cognitive and emotional conse- LAY ABSTRACT This secondary analysis of a previous study evaluated the effects of enhanced client-centred intervention af- ter stroke. The aim was to explore factors that could impact the client’s participation in everyday life after stroke. The factors explored were the characteristics of the client (their age, sex, stroke severity, and level of participation in everyday life before the stroke); the context in which the rehabilitation took place (at hospi- tal or in the client’s home) and rehabilitation approach (receiving rehabilitation with an enhanced client-cent- red approach or not). In order to increase participation in everyday life for people after stroke it appears to be important to employ an enhanced client-centred reha- bilitation approach, particularly when working within in- patient rehabilitation and with people with moderate or severe stroke. quences can have a substantial impact on a person’s participation in everyday life at home and in society (2–5). The client-centred approach is highlighted in occupational therapy models (6, 7) and recommended for rehabilitation after stroke in order to achieve a suc- cessful rehabilitation outcome. To increase the clients’ involvement in the rehabilitation process it is important to collaborate with the client, and to focus on the needs and wishes of the client (8–10). Being able to partici- pate in meaningful activities can promote health and life satisfaction for people with long-term conditions such as stroke, and is often expressed as the overall goal in rehabilitation (11, 12). However, participation is a complex concept that has been defined in various ways, such as being included and accepted in society, involvement in one’s life situation (13), and having the will, ability and opportunity to perform an activity (14). In this study, participation in everyday life was considered to include actual performance of activities, the meaning of and engagement in activities, and having control and freedom of choice (6, 7, 11). An enhanced client-centred activities of daily living (ADL) intervention has previously been developed for rehabilitation after stroke and evaluated in a cluster ran- domized controlled trial (RCT) (15, 16). The enhanced client-centred intervention provided therapists with a This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2523 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977