title: Participation in Complex and Social Everyday Activities Six Years after Stroke: Predictors for Return to Pre-Stroke Level.
abstract: BACKGROUND
  Long-term disability following stroke can lead to participation restrictions in complex and social everyday activities, yet information is lacking on to what extent stroke survivors return to their pre-stroke levels of participation.
  
  
  OBJECTIVE
  The objectives of this study were to investigate the level of participation in complex and social everyday activities 6 years after stroke, to compare this with pre-stroke participation and to identify predictors of returning to pre-stroke levels of participation.
  
  
  METHODS
  All patients admitted to Karolinska University Hospital's stroke units during a 1-year period were eligible to participate and 349 patients were recruited. Assessments were made at base-line, 3 months and 6 years using self-reported outcome measures. Participation was assessed using the Frenchay Activities Index (FAI). The 6-year score for each participant was compared to the pre-stroke score, both for the total score and for each domain (domestic chores, leisure/work and outdoor activities). Predictors of having the same or better level of participation at 6 years were identified using logistic regression.
  
  
  RESULTS
  At 6 years, 121 participants were followed up, 166 were deceased, 44 declined to take part and 18 could not be traced. At 6 years 84% could be described as active (FAI≥15). The same level of participation or better than pre-stroke was found in 35% of participants, in 65% the level was lower. Similar predictors were identified for achieving the same or better level of participation at 6 years for FAI total and the three domains; ability to walk without aids and a lower age at stroke onset, and perceived mobility, participation and recovery at 3 months.
  
  
  CONCLUSIONS
  Six years after stroke, 35% of participants had the same or better level of participation as pre-stroke. Rehabilitation after stroke to improve walking ability and participation might improve long-term participation in complex and social everyday activities.
authors.affiliation: Nyköpings Hospital, Nyköping, Sweden.|Karolinska Institutet, Stockholm, Sweden.
authors.forename: Avvai
authors.initials: A
authors.lastname: Singam
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.|Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ytterberg
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.|Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Tham
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.|Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: von Koch
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D058992:Social Participation; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors; D016138:Walking / Q000502:physiology