title: Determinants of participation restriction among community dwelling stroke survivors: a path analysis.
abstract: BACKGROUND
  Apart from promoting physical recovery and assisting in activities of daily living, a major challenge in stroke rehabilitation is to minimize psychosocial morbidity and to promote the reintegration of stroke survivors into their family and community. The identification of key factors influencing long-term outcome are essential in developing more effective rehabilitation measures for reducing stroke-related morbidity. The aim of this study was to test a theoretical model of predictors of participation restriction which included the direct and indirect effects between psychosocial outcomes, physical outcome, and socio-demographic variables at 12 months after stroke.
  
  
  METHODS
  Data were collected from 188 stroke survivors at 12 months following their discharge from one of the two rehabilitation hospitals in Hong Kong. The settings included patients' homes and residential care facilities. Path analysis was used to test a hypothesized model of participation restriction at 12 months.
  
  
  RESULTS
  The path coefficients show functional ability having the largest direct effect on participation restriction (beta = 0.51). The results also show that more depressive symptoms (beta = -0.27), low state self-esteem (beta = 0.20), female gender (beta = 0.13), older age (beta = -0.11) and living in a residential care facility (beta = -0.12) have a direct effect on participation restriction. The explanatory variables accounted for 71% of the variance in explaining participation restriction at 12 months.
  
  
  CONCLUSIONS
  Identification of stroke survivors at risk of high levels of participation restriction, depressive symptoms and low self-esteem will assist health professionals to devise appropriate rehabilitation interventions that target improving both physical and psychosocial functioning.
authors.affiliation: Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong. janitachau@cuhk.edu.hk
authors.forename: Janita P C
authors.initials: JP
authors.lastname: Chau
authors.forename: David R
authors.initials: DR
authors.lastname: Thompson
authors.forename: Sheila
authors.initials: S
authors.lastname: Twinn
authors.forename: Anne M
authors.initials: AM
authors.lastname: Chang
authors.forename: Jean
authors.initials: J
authors.lastname: Woo
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000342:Affective Symptoms / Q000209:etiology / Q000534:rehabilitation; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011788:Quality of Life; D012112:Residential Facilities; D012648:Self Care; D012649:Self Concept; D012944:Social Support; D020521:Stroke / Q000150:complications / Q000191:economics / Q000523:psychology*; D000071939:Stroke Rehabilitation