Factors affecting outcome in participation one year after stroke: A secondary analysis of a randomized controlled trial

This secondary analysis of a previous study evaluated the effects of enhanced client-centred intervention after 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 hospital or in the client's home) and rehabilitation approach (receiving rehabilitation with an enhanced client-centred 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 rehabilitation approach, particularly when working within inpatient rehabilitation and with people with moderate or severe stroke.Objective: To explore the importance of client characteristics (age, sex, stroke severity and participation before stroke), rehabilitation context (in-patient or client's home) and approach (enhanced clientcenteredness or not) on participation in every day life after stroke.Methods: A secondary analysis of data on 237 participants 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 participation were used: Stroke Impact Scale 3.0, domain participation; Frenchay Activities Index; and Occupational Gaps Questionnaire.Results: For all participants there was a significant association between mild stroke and a positive outcome using the Frenchay Activities Index.Among participants who had not received the enhanced client-centred approach, there was a significant association between mild stroke and a positive outcome 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 approach, particularly when working within in-patient rehabilitation and with people with moderate or severe stroke.

Abstract licence: CC BY-NC

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