Community integration and its predictors in people with stroke: a multicenter longitudinal study

Authors

  • Jiang-Li Zhao Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
  • Lian-Dong Ma Department of Acupuncture and Rehabilitation Medicine, The Second Traditional Chinese Medicine Hospital, Guangzhou, China
  • Xiang Xiao Department of Rehabilitation Medicine, The Shenzhen Luohu Hospital Group Luohu People's Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, China
  • Li-Jun Lin Department of Acupuncture and Rehabilitation Medicine, The Second Traditional Chinese Medicine Hospital, Guangzhou, China
  • Hao Xie Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
  • Shamay S.M. Ng Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
  • Pei-Ming Chen Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China

DOI:

https://doi.org/10.2340/jrm.v56.21372

Keywords:

stroke, rehabilitation, community integration, community integration questionnaire, balance function, ability of daily living

Abstract

Objective: To investigate the community integration of patients following stroke and determine the predictors of their level of community integration at 1-year follow-up.

Design: A multicenter, longitudinal, and observational study.

Subjects: Sixty-five inpatients (41 men) with a mean age of 56.9 (standard deviation = 17.0) years, who had their first stroke at least 1 month prior to this study were recruited from 4 rehabilitation inpatient wards in China.

Methods: In the initial assessment, the participants were evaluated using the Community Integration Questionnaire, the Fugl-Meyer Assessment, the Berg Balance Scale, the Modified Barthel Index, the Mini Mental State Examination, and the Modified Ashworth Scale. In the follow-up assessments, which were conducted via telephone no less than 1 year after discharge, the participants were evaluated using the Community Integration Questionnaire and also assessed for other disease-related conditions.

Results: The participants’ scores on the Community Integration Questionnaire in the follow-up assessment were significantly greater than those at the initial assessment (p < 0.05). In addition, the participants’ Community Integration Questionnaire scores in the follow-up assessment were significantly correlated with their ages, numbers of years of education, and Modified Barthel Index, Berg Balance Scale, Mini Mental State Examination scores in the initial assessment (p < 0.05), and marginally significantly correlated with their scores on Fugl-Meyer Assessment in the initial assessment (p = 0.058). The participants’ ages, numbers of years of education, and Modified Barthel Index, Berg Balance Scale, Mini Mental State Examination, Fugl-Meyer Assessment of the lower extremity, and Fugl-Meyer Assessment scores in the initial assessment were predictive of their Community Integration Questionnaire scores at follow-up, with coefficients of determination ranging from 0.254 to 0.056 (p < 0.05).

Conclusions: The level of community integration of the participants was generally low, but it was greater at 1-year follow-up than it was initially. Balance function and daily living ability may be key predictors of community integration of patients following stroke.

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References

Stinear CM, Lang CE, Zeiler S, Byblow WD. Advances and challenges in stroke rehabilitation. Lancet Neurol 2020; 19: 348–360.

https://doi.org/10.1016/S1474-4422(19)30415-6 DOI: https://doi.org/10.1016/S1474-4422(19)30415-6

Li L. Support programme for secondary prevention of stroke: inspiration to continue? Lancet Neurol 2020; 19: 24–25.

https://doi.org/10.1016/S1474-4422(19)30410-7 DOI: https://doi.org/10.1016/S1474-4422(19)30410-7

Dimyan MA, Cohen LG. Neuroplasticity in the context of motor rehabilitation after stroke. Nat Rev Neurol 2011; 7: 76–85.

https://doi.org/10.1038/nrneurol.2010.200 DOI: https://doi.org/10.1038/nrneurol.2010.200

Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson

TB, Flegal K, et al. Heart disease and stroke statistics – 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009; 119: 480–486.

https://doi.org/10.1161/CIRCULATIONAHA.108.191259 DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.191259

Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 2014; 383: 245–254.

https://doi.org/10.1016/s0140-6736(13)61953-4 DOI: https://doi.org/10.1016/S0140-6736(13)61953-4

Migliorini C, Enticott J, Callaway L, Moore S, Willer B. Community integration questionnaire: outcomes of people with traumatic brain injury and high support needs compared with multiple matched controls. Brain Injury 2016; 30: 1201–1207.

https://doi.org/10.1080/02699052.2016.1175666 DOI: https://doi.org/10.1080/02699052.2016.1175666

Willer B, Ottenbacher KJ, Coad ML. The community integration questionnaire: a comparative examination. Am J Phys Med Rehab 1994; 73: 103–111.

https://doi.org/10.1097/00002060-199404000-00006 DOI: https://doi.org/10.1097/00002060-199404000-00006

Lee H, Lee Y, Choi H, Pyun SB. Community integration and quality of life in aphasia after stroke. Yonsei Med J 2015; 56: 1694–1702.

https://doi.org/10.3349/ymj.2015.56.6.1694 DOI: https://doi.org/10.3349/ymj.2015.56.6.1694

Liu Q, Ma Y, Yang. L. Reliability and validity of Chinese version of Community Integration Questionnaire among the disabled. J Prev Med Chin Pla 2017; 35: 255–259.

Rejno A, Nasic S, Bjalkefur K, Bertholds E, Jood K. Changes in functional outcome over five years after stroke. Brain Behav 2019; 9: e1300.

https://doi.org/10.1002/brb3.1300 DOI: https://doi.org/10.1002/brb3.1300

Joseph C, Rhoda A. Activity limitations and factors influencing functional outcome of patients with stroke following rehabilitation at a specialised facility in the Western Cape. Afr Health Sci 2013; 13: 646–654.

https://doi.org/10.4314/ahs.v13i3.18 DOI: https://doi.org/10.4314/ahs.v13i3.18

Verberne D, Post M, Kohler S, Carey LM, Visser-Meily J, van Heugten CM. Course of social participation in the first 2 years after stroke and its associations with demographic and stroke-related factors. Neurorehab Neural Repair 2018; 32: 821–833.

https://doi.org/10.1177/1545968318796341 DOI: https://doi.org/10.1177/1545968318796341

Singam A, Ytterberg C, Tham K, von Koch L. Participation in complex and social everyday activities six years after stroke: pre-dictors for return to pre-stroke level. Plos One 2015; 10: e144344.

https://doi.org/10.1371/journal.pone.0144344 DOI: https://doi.org/10.1371/journal.pone.0144344

Dalemans RJ, de Witte LP, Beurskens AJ, van den Heuvel WJ, Wade DT. Psychometric properties of the community integration questionnaire adjusted for people with aphasia. Arch Phys Med Rehab 2010; 91: 395–399.

https://doi.org/10.1016/j.apmr.2009.10.021 DOI: https://doi.org/10.1016/j.apmr.2009.10.021

Gladstone DJ, Danells CJ, Black SE. The Fugl–Meyer assessment of motor recovery after stroke: a critical review of its measure-ment properties. Neurorehab Neural Repair 2002; 16: 232–240.

https://doi.org/10.1177/154596802401105171 DOI: https://doi.org/10.1177/154596802401105171

Sullivan KJ, Tilson JK, Cen SY, Rose DK, Hershberg J, Correa A, et al. Fugl–Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials. Stroke 2011; 42: 427–432.

https://doi.org/10.1161/STROKEAHA.110.592766 DOI: https://doi.org/10.1161/STROKEAHA.110.592766

Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Therapy 2008; 88: 559–566.

https://doi.org/10.2522/ptj.20070205 DOI: https://doi.org/10.2522/ptj.20070205

Chou CY, Chien CW, Hsueh IP, Sheu CF, Wang CH, Hsieh CL. Developing a short form of the Berg Balance Scale for people with stroke. Phys Therapy 2006; 86: 195–204. DOI: https://doi.org/10.1093/ptj/86.2.195

Perez MJ, Flores AM, Castro SA, Tapia HR, Garcia RM, Aguilar FM. Inpatient dependency in activities of daily living predicts informal caregiver strain: a cross-sectional study. J Clin Nurs 2018; 27: e177–e185.

https://doi.org/10.1111/jocn.13900 DOI: https://doi.org/10.1111/jocn.13900

Yang H, Chen Y, Wang J, Wei H, Chen Y, Jin J. Activities of daily living measurement after ischemic stroke: Rasch analysis of the modified Barthel Index. Medicine 2021; 100: e24926.

https://doi.org/10.1097/MD.0000000000024926 DOI: https://doi.org/10.1097/MD.0000000000024926

Jia X, Wang Z, Huang F, Su C, Du W, Jiang H, et al. A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: a cross-sectional study. BMC Psychiatry 2021; 21: 485.

https://doi.org/10.1186/s12888-021-03495-6 DOI: https://doi.org/10.1186/s12888-021-03495-6

Hornsten C, Littbrand H, Bostrom G, Rosendahl E, Lundin-Olsson L, Nordstrom P, et al. Measurement error of the Mini-Mental State Examination among individuals with dementia that reside in nursing homes. Eur J Ageing 2021; 18: 109–115.

https://doi.org/10.1007/s10433-020-00572-9 DOI: https://doi.org/10.1007/s10433-020-00572-9

Meseguer-Henarejos AB, Sanchez-Meca J, Lopez-Pina JA, Carles-Hernandez R. Inter- and intra-rater reliability of the Modified Ashworth Scale: a systematic review and meta-analysis. Eur J Phys Rehab Med 2018; 54: 576–590.

https://doi.org/10.23736/S1973-9087.17.04796-7 DOI: https://doi.org/10.23736/S1973-9087.17.04796-7

Mayo NE, Wood-Dauphinee S, Cote R, Durcan L, Carlton J. Activity, participation, and quality of life 6 months poststroke. Arch Phys Med Rehab 2002; 83: 1035–1042.

https://doi.org/10.1053/apmr.2002.33984 DOI: https://doi.org/10.1053/apmr.2002.33984

Tateno A, Kimura M, Robinson RG. Phenomenological characteristics of poststroke depression: early- versus late-onset. Am J Geriat Psychiat 2002; 10: 575–582. DOI: https://doi.org/10.1176/appi.ajgp.10.5.575

van Velzen JM, van Bennekom CA, Edelaar MJ, Sluiter JK, Frings-Dresen MH. How many people return to work after acquired brain injury?: a systematic review. Brain Injury 2009; 23: 473–488.

https://doi.org/10.1080/02699050902970737 DOI: https://doi.org/10.1080/02699050902970737

Code C, Hemsley G, Herrmann M. The emotional impact of aphasia. Semin Speech Lang 1999; 20: 19–31.

https://doi.org/10.1055/s-2008-1064006 DOI: https://doi.org/10.1055/s-2008-1064006

Northcott S, Hilari K. Why do people lose their friends after a stroke? Int J Lang Comm Dis 2011; 46: 524–534.

https://doi.org/10.1111/j.1460-6984.2011.00079.x DOI: https://doi.org/10.1111/j.1460-6984.2011.00079.x

Doig E, Fleming J, Tooth L. Patterns of community integration 2–5 years post-discharge from brain injury rehabilitation. Brain Injury 2001; 15: 747–762.

https://doi.org/10.1080/02699050110034343 DOI: https://doi.org/10.1080/02699050110034343

Kaplan CP. The community integration questionnaire with new scoring guidelines: concurrent validity and need for appropriate norms. Brain Injury 2001; 15: 725–731. DOI: https://doi.org/10.1080/02699050121559

https://doi.org/10.1080/02699050010005913 DOI: https://doi.org/10.1080/02699050010005913

Perry SB, Woollard J, Little S, Shroyer K. Relationships among measures of balance, gait, and community integration in people with brain injury. J Head Trauma Rehab 2014; 29: 117–124.

https://doi.org/10.1097/HTR.0b013e3182864f2f DOI: https://doi.org/10.1097/HTR.0b013e3182864f2f

Matos I, Fernandes A, Maso I, Oliveira-Filho J, de Jesus PA, Fraga-Maia H, et al. Investigating predictors of community integration in individuals after stroke in a residential setting: a longitudinal study. Plos One 2020; 15: e233015.

https://doi.org/10.1371/journal.pone.0233015 DOI: https://doi.org/10.1371/journal.pone.0233015

Cattaneo D, Gervasoni E, Pupillo E, Bianchi E, Aprile I, Imbimbo I, et al. Mobility disorders in stroke, Parkinson disease, and multiple sclerosis: a multicenter cross-sectional study. Am J Phys Med Rehab 2020; 99: 41–47.

https://doi.org/10.1097/PHM.0000000000001272 DOI: https://doi.org/10.1097/PHM.0000000000001272

Bruijn SM, van Dieen JH. Control of human gait stability through foot placement. J R Soc Interface 2018; 15.

https://doi.org/10.1098/rsif.2017.0816 DOI: https://doi.org/10.1098/rsif.2017.0816

Hinemann AW, Whiteneck GG. Relationships among impairment, disability, handicap, and life satisfaction in persons with traumatic brain injury. J Head Trauma Rehab 1995; 10: 54–63.

https://doi.org/doi:10.1097/00001199-199508000-00006 DOI: https://doi.org/10.1097/00001199-199508000-00006

Walsh ME, Galvin R, Loughnane C, Macey C, Horgan NF. Factors associated with community reintegration in the first year after stroke: a qualitative meta-synthesis. Disabil Rehabil 2015; 37: 1599–1608.

https://doi.org/10.3109/09638288.2014.974834 DOI: https://doi.org/10.3109/09638288.2014.974834

Pahwa R, Smith ME, Patankar KU, Ghosh S. Social networks, community integration and recovery for individuals with severe mental illnesses in India and the U.S: a comparative study. Community Ment Health J 2020; 56: 1004–1013.

https://doi.org/10.1007/s10597-019-00546-x DOI: https://doi.org/10.1007/s10597-019-00546-x

Terry R, Townley G. Exploring the role of social support in promoting community integration: an integrated literature review. Am J Commun Psychol 2019; 64: 509–527.

https://doi.org/10.1002/ajcp.12336 DOI: https://doi.org/10.1002/ajcp.12336

Published

2024-04-25

How to Cite

Zhao, J.-L., Ma, L.-D., Xiao, X., Lin, L.-J., Xie, H., Ng, S. S., & Chen, P.-M. (2024). Community integration and its predictors in people with stroke: a multicenter longitudinal study. Journal of Rehabilitation Medicine, 56, jrm21372. https://doi.org/10.2340/jrm.v56.21372

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Original Report

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