Community Participation in Stroke Survivors

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Stroke has been classified as the most disabling chronic disease, with deleterious consequences for individuals, families, and society1. Stroke impacts on all domains in the ICF. The body dimension (body functions and structures), the individual dimension (activity), and the social dimension (participation). All domains influence each other2. Participation is defined as one’s involvement in life and social situations, and includes interpersonal interactions and involvement in relationships, major life areas, and community, social, and civic life3.Community participation is one of the most important elements of stroke rehabilitation. Perceived participation in community activities represents an individual’s perception of satisfaction with his or her involvement in life situations. Many people with stroke have a low level of satisfaction with community reintegration after they are discharged from the hospital and return to the community4. Researchers reported that 39% to 65% of community-dwelling people with stroke reported limitations in daily activities and restrictions in reintegration into the community. Research on persons with disabilities has shown that a satisfactory return to the community, compared with the performance of daily activities (ADLs and IADLs), is more strongly correlated with enhanced QoL5. Stroke-specific research indicates that decreased in participation after stroke has been linked to negative outcomes. In particular, limitations in participation have been linked to worse health and functional status, depression, increased health care utilization, decreased independence, increased social isolation, and declines in overall QoL and life satisfaction6,7. Stroke survivors unable to continue their previous meaningful activities, including social role, have demonstrated increased post stroke depression6, 8. Traditional physiotherapy has been focusing on the restoration of sensorimotor function (e.g., Muscle strength, movement coordination, spasticity, balance) and performance in certain daily activities such as ambulation. However, relatively less attention is paid to community integration after stroke, which involves several important elements, including participation in activities at home or a homelike setting, engagement in productive activities, and establishment and enjoyment of a social network9. Apart from Concentrating on body and individual dimensions and 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 community. Despite favorable exercise methods having been achieved for people with stroke, questions remain as to why such exercise benefits are not necessarily linked to good levels of community participation. It may be that rehabilitation efforts need to be refined to achieve a satisfactory level of community.

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