title: Understanding stroke survivorship: expanding the concept of poststroke disability.
abstract: OBJECTIVE
  Limitations in essential daily activities are common among older adults after stroke, but little is known about restrictions in their ability to participate in valued social activities. We sought to broaden our understanding of disability after stroke by characterizing poststroke participation restrictions and investigating the extent to which they are accounted for by differences in physical and cognitive capacity, aphasia/dysarthria, depressive, and anxiety symptoms.
  
  
  METHODS
  Data from the 2011 National Health and Aging Trends Study (NHATS) were used to identify 892 self-reported stroke survivors aged≥65 years. One-to-one propensity matching was performed on demographics and comorbidities to create a matched sample. Participation restrictions were defined as reductions/absence in social activities valued by respondents because of their health or functioning. Physical and cognitive capacity, depressive and anxiety symptoms were measured by validated scales and aphasia/dysarthria by a single question. Comparisons using survey-weighted χ2 tests and logistic regression were made.
  
  
  RESULTS
  Stroke survivors had more participation restrictions (32.8% versus 23.5%; odds ratio, 1.59; 95% confidence interval, 1.28-1.95; P<0.01) than controls. Differences between stroke survivors and controls in any participation restriction and several components (attending religious service, clubs/classes, and going out for enjoyment) were eliminated after adjusting for physical capacity. Depressive and anxiety symptoms and aphasia/dysarthria were independent predictors of participation restrictions.
  
  
  CONCLUSIONS
  Stroke survivors have more participation restrictions than can be accounted for by sociodemographic profiles and comorbidity burden. Future work aimed at improving physical capacity, reducing depressive and anxiety symptoms, and improving aphasia/dysarthria has potential to enhance participation.
authors.affiliation: From the Stroke Program (L.E.S., J.F.B., D.L.B.) and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor; and Center for Clinical Management and Research, Ann Arbor, VA (J.F.B.).
authors.forename: Lesli E
authors.initials: LE
authors.lastname: Skolarus
authors.forename: James F
authors.initials: JF
authors.lastname: Burke
authors.forename: Devin L
authors.initials: DL
authors.lastname: Brown
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Freedman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation; D004522:Educational Status; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D009043:Motor Activity; D009460:Neurologic Examination; D015995:Prevalence; D012919:Social Behavior; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology* / Q000523:psychology; D017741:Survivors / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
keywords: disability evaluation; patient participation