Investigating predictors of community integration in individuals after stroke in a residential setting: A longitutinal study

PLoS One. 2020 May 18;15(5):e0233015. doi: 10.1371/journal.pone.0233015. eCollection 2020.

Abstract

Aim: To identify potential predictors of community integration in individuals after stroke using a residential setting-based strategy.

Method: A prospective cohort of post-stroke individuals was recruited from the Stroke Unit of the Roberto Santos General Hospital (UAVC-HGRS). All included individuals were aged over 18 years, received a diagnosis of ischemic stroke confirmed by neuroimaging and resided in the city of Salvador (Bahia, Brazil). Following discharge from the stroke unit, the individuals themselves, or their responsible parties, were contacted by telephone to schedule a home visit no less than three months after discharge. All subjects were examined in their homes, at which time the Community Integration Questionnaire (CIQ) was also applied. A robust linear regression model was used to assess community reintegration using CIQ score as the outcome variable.

Results: A total of 124 individuals effectively fulfilled the eligibility criteria: 51.6% were females, the median (IQR) age was 63(53-69) years, 82.3% were non-white, 53.2% were married, the median (IQR) of years of schooling was 6 (4-12) and family income averaged two minimum monthly wages. Investigated individuals presented a median (IQR) NIH Stroke Scale (NIHSS) score of 7 (4-12). Multivariate linear regression identified the following independent predictors of community integration: age (β = -0.095; 95% CI = -0.165 to -0.025; p = 0.008), diabetes mellitus (β = -2.348; 95% CI = -4.125 to -0.571; p = 0.010), smoking habit (β = -2.951; 95% CI = -5.081 to -0.821; p = 0.007), functional capacity upon hospital discharge (β = 0.168; 95% CI = 0.093 to 0.242; p = <0.001) and stroke severity (β = -0.163; CI = -0.318 to -0.009); p = 0.038).

Conclusions: Regardless of length of time since stroke, individuals present restrictions that compromise their reintegration into their respective communities. The demographic, clinical and functional factors identified herein as potential predictors should be considered when conducting regular follow-up, as well as in the rehabilitation of individuals after stroke with the purpose to identify the interventions necessary to optimize their reintegration into the community.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Aged
  • Brazil
  • Community Integration / psychology*
  • Female
  • Humans
  • Linear Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Patient Discharge
  • Prospective Studies
  • Quality of Life / psychology*
  • Socioeconomic Factors
  • Stroke / psychology*
  • Surveys and Questionnaires

Grants and funding

With regard to funding, Adriana Fernandes and Isabela Matos received scholarship grants during the study period from the Coordination Program for Personal Improvement in Higher Education (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-CAPES). None of the other authors received any specific funding for this work The funders has no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.