title: 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.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Community.
  
  
  METHODS
  An inception cohort of adults (N=67) who had been discharged from an acute stroke unit or stroke rehabilitation unit after a first stroke.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada. Electronic address: megan@uottawa.ca.
authors.forename: Mary
authors.initials: M
authors.lastname: Egan
authors.affiliation: Department of Psychology, Carleton University, Ottawa, ON, Canada.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Davis
authors.affiliation: School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Claire-Jehanne
authors.initials: CJ
authors.lastname: Dubouloz
authors.affiliation: School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Kessler
authors.affiliation: School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Lucy-Ann
authors.initials: LA
authors.lastname: Kubina
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology* / Q000523:psychology*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
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