Participation and well-being poststroke: evidence of reciprocal effects

Abstract

Objective: To explore reciprocal effects between participation and emotional and physical well-being during the first 2 years poststroke.

Design: Prospective cohort study.

Setting: Community.

Participants: An inception cohort of adults (N=67) who had been discharged from an acute stroke unit or stroke rehabilitation unit after a first stroke.

Interventions: Not applicable.

Main outcome measures: Participation (Reintegration to Normal Living Index), emotional well-being (General Well-being Schedule), and physical well-being (General Self-rating of Health Question) were measured at 6, 9, 12, 18, and 24 months poststroke. Hierarchical linear modeling was used to examine the association between participation and change in well-being, controlling for sex, age, impairment (discharge FIM), and median neighborhood income.

Results: Greater engagement in valued activities was significantly associated with subsequent improvement in emotional well-being. The effect of participation on change in physical well-being was marginal. Higher levels of well-being also predicted subsequent increases in participation, with emotional well-being effects moderated by income, and physical well-being effects moderated by level of impairment.

Conclusions: Our results support a 2-pronged approach to addressing well-being poststroke where efforts to improve affect and boost participation are simultaneously applied.

Keywords: GHQ; GWB; General Self-rating of Health Question; General Well-being Schedule; Health; Human activities; ICC; ICF; International Classification of Functioning, Disability and Health; Longitudinal studies; RNLI; Rehabilitation; Reintegration to Normal Living Index; Stroke; intraclass correlation coefficient.