title: Does the frequency of participation change after stroke and is this change associated with the subjective experience of participation?
abstract: OBJECTIVE
  To investigate changes in the frequency of participation 6 months poststroke compared with prestroke; and to establish whether the change is associated with participation restrictions and satisfaction with participation 6 months poststroke.
  
  
  METHODS
  Inception cohort study. Prestroke frequency of participation was measured retrospectively in the first week poststroke. Frequency, participation restrictions, and satisfaction with participation were assessed 6 months poststroke.
  
  
  METHODS
  General hospitals and home residences.
  
  
  METHODS
  Patients with stroke (N=325; 65.5% men; mean age, 66.9±12.2y) admitted to 1 of 6 participating general hospitals.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Utrecht Scale for Evaluation of Rehabilitation-Participation (0-100), which consists of 3 scales: frequency, restrictions, and satisfaction. The frequency scale consists of 2 parts: vocational activities (work, volunteer work, education, household activities) and leisure and social activities.
  
  
  RESULTS
  Vocational activities showed a large decrease (effect size: 0.6) poststroke; leisure and social activities showed a small decrease (effect size: 0.13) poststroke. In multiple regression analyses, both the frequency of participation in vocational activities 6 months poststroke and the decrease in vocational activities compared with before the stroke were significantly associated with the participation restrictions experienced and satisfaction with participation after controlling for age, sex, level of education, dependency in activities of daily living, cognitive functioning, and presence of depressive symptoms. The presence of depressive symptoms showed the strongest association with the subjective experience of participation.
  
  
  CONCLUSIONS
  The frequency of participation decreased after a stroke, and this decrease was associated with participation restrictions experienced and satisfaction with participation. Resuming vocational activities and screening and, if applicable, treatment of depressive symptoms should be priorities in stroke rehabilitation.
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
authors.forename: Anne-Marije V
authors.initials: AM
authors.lastname: Blömer
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
authors.forename: Maria L
authors.initials: ML
authors.lastname: van Mierlo
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Visser-Meily
authors.affiliation: Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: van Heugten
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: m.post@dehoogstraat.nl.
authors.forename: Marcel W
authors.initials: MW
authors.lastname: Post
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003710:Demography; D004185:Disability Evaluation; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010549:Personal Satisfaction; D012189:Retrospective Studies; D012307:Risk Factors; D058992:Social Participation; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D013997:Time Factors
keywords: Rehabilitation; Social participation; Stroke