Social participation following a stroke: an assessment in accordance with the international classification of functioning, disability and health

Abstract

Objective: Evaluate, code and qualify the participation of Brazilian stroke survivors based on the international classification of functioning, disability and health (ICF) and identify predictors of post-stroke participation.

Methods: An exploratory, observational, cross-sectional study was conducted involving 78 individuals with hemiparesis stemming from a stroke. The stroke specific quality of life (SS-QOL) was used to evaluate the participation component of the ICF. The geriatric depression scale was used to screen depressive symptoms; the functional independence measure (FIM) was used to measure the degree of dependence; grip strength was determined using a dynamometer; and cognitive status was evaluated using the mini mental state examination. The one-way analysis of variance followed by the Bonferroni test was used for the comparison the participation scores of different groups (age and marital status). The independent t-test was used for the comparisons of the other groups (sex, time since the occurrence of stroke (<12 months or >12 months) and degree of functional independence). Multiple linear regression was employed to identify measures capable of predicting participation.

Results: Based on the classification and qualifiers of the ICF, the individuals analyzed exhibited a moderate level of participation. Participation was significantly associated with time since the occurrence of stroke (F = 2.46; 95% confidence interval (CI) = −23.67–0.34; p = 0.05), degree of functional independence (F = 2.40; 95% CI = −33.0 to −18.93; p < 0.001) and marital status (married or widowed) (F = 2.6; p = 0.05). No statistically significant associations were found with regard to age, sex or affected side of the body. Functional independence was the main predictor of participation (F = 99.2; r² = 0.57; p <0.001) and the occurrence of depressive symptoms was a moderate predictor (F =12.78; r² = 0.40; p = 0.001).

Conclusions: Twenty-four ICF categories were coded and qualified with the use of the SS-QOL, enabling the participation component of the ICF biopsychosocial model to be easily evaluated in clinical practice. Overall, the sample in the present study demonstrated a moderate decline in participation following a stroke and only the “social roles” domain was severely affected. The FIM was the main predictor of participation and the depression was a moderate predictor. Therefore, health professionals involved in the rehabilitation of these patients should focus on the promotion of functional independence and improvements in emotional health to optimize social participation following a stroke.

Implications for Rehabilitation

• The Brazilian stroke individuals analyzed exhibited a moderate level of participation.

• Functional independence was the main predictor of participation and the occurrence of depressive symptoms was a moderate predictor. Age, sex and affected side of the body were not predictors of participation.

• Our findings support that twenty-four International classification of functioning, disability and health categories were coded and qualified with the use of the stroke specific quality of life.

• Rehabilitation of social functioning post stroke patients should be focused on the promotion of functional independence and improvement in emotional health.

• This study offers a participation assessment model that can facilitate the incorporation of the ICF in the clinical practice.

Keywords:

• Stroke
• social participation
• international classification of functioning
• disability and health

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study received funding from the Brazilian fostering agency State of São Paulo Research Assistance Foundation (FAPESP; process number: 15/10659-5).