Content and Effectiveness of Interventions Focusing on Community Participation Poststroke: A Systematic Review

Abstract

Objective: To investigate the content and effectiveness of interventions that address poststroke community participation.

Data sources: EMBASE, PsycINFO, PubMed, and Cumulative Index to Nursing and Allied Health (CINAHL) were searched using 3 indexing terms and respective thesaurus: stroke, social participation, and clinical trials. Filters for English, publication dates (January 2001-May 2017), and publication types were used. The search also included checking references from relevant systematic reviews.

Study selection: Studies conducted with adults with stroke, evaluating interventions addressing community participation, having a comparison group, and reporting at least 1 of 3 outcomes (participation, depression, and health-related quality of life) were selected. Retrieved articles were screened by 2 reviewers. After substantial agreement was achieved using interrater reliability, reviewers screened articles independently. Eighteen of 1130 articles were included.

Data extraction: Characteristics of participants, key elements of intervention, comparator, and results were independently extracted by 2 reviewers. Intervention content was categorized based on 9 categories from the International Classification of Functioning, Disability, and Health Activities and Participation domains. Risk of selection, performance, attrition, and reporting bias were evaluated.

Data synthesis: Two intervention categories were identified: leisure participation and community integration. Three leisure and 4 community integration interventions showed significant group differences favoring the intervention group in the target outcomes. The majority of interventions addressed the leisure, interpersonal relations, and community life categories of International Classification of Functioning, Disability, and Health with few focusing on political life, education, assisting others, and religion.

Conclusions: A limited number of studies showed an effect on participation, depression, and health-related quality of life outcomes. There were gaps in intervention content indicating that current community participation interventions fall short in addressing full inclusion and citizenship of people with stroke. Future interventions should focus on civic- and societal-level participation and community activities beyond leisure.

Keywords: Community participation; Disability, and Health; International Classification of Functioning; Rehabilitation; Social participation; Stroke; Systematic review.