Longitudinal changes in activity participation in the first year post-stroke and association with depressive symptoms

Abstract

Research question: 1. Does activity participation improve over time in the first year after stroke? 2. What is the association of depressive symptoms on retained activity participation 12-months post-stroke adjusting for neurological stroke severity and age? 3. Is an improvement in activity participation associated with a decrease in depressive symptoms between 3- and 12-months post-stroke?

Design: Longitudinal observational study of activity participation and depressive symptoms in ischemic stroke survivors.

Participants: A total of 100 stroke survivors with mild neurological stroke severity.

Methods: A total of 100 stroke survivors were recruited from five metropolitan hospitals and assessed at 3- and 12-months post-stroke using measures of activity participation (Activity Card Sort-Australia (ACS-Aus)) and depressive symptoms (Montgomery–Asberg Depression Rating Scale Structured Interview Guide (MADRS-SIGMA)).

Results: There was a significant association between time (pre-stroke to 3-months post-stroke) and current activity participation (−5.2 activities 95% CI −6.8 to −3.5, p < 0.01) and time (pre-stroke to 12-months) and current activity participation (−2.1 activities 95% CI −3.7 to −0.5, p = 0.01). At 12-months post-stroke, a one-point increase in depressive symptoms was associated with a median decrease of 0.3% (95% CI −1.4% to −0.1%, p = 0.02) of retained overall activity participation, assuming similar neurological stroke severity and age. A decrease in depressive symptoms between 3- and 12-months post-stroke was associated with an improvement of 0.31 (95% CI −0.5 to −0.1, p = 0.01) in current activity participation.

Conclusions: Activity participation improves during the first year of recovery post-stroke in stroke survivors with mild neurological stroke severity and is associated with depressive symptoms over time and at 12-months post-stroke.

Implications for rehabilitation

• Improvements in participation occur in the first 3-months post-stroke and continue to a lesser degree in the first year after stroke.

• Depressive symptoms are associated with lower participation at 12-months.

• A multidimensional approach targeting depressive symptoms and increasing participation in the early months post-stroke and throughout the first-year after stroke is recommended to increase overall recovery following stroke.

• A focus on increasing leisure activity participation is recommended to improve depressive symptoms.

Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12610000987066.

Keywords:

• Stroke
• social participation
• human activities
• depression
• recovery of function
• rehabilitation

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Commonwealth Scientific and Industrial Research Organization (CSIRO) of Australia, Flagship Collaboration Fund through the Preventative Health Flagship; the James S. McDonnell Foundation 21st Century Science Initiative in Cognitive Rehabilitation-Collaborative Award [#220020413]; and NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Injury [#1077898].