Participation in the chronic phase of stroke

Top Stroke Rehabil. 2013 Jan-Feb;20(1):52-61. doi: 10.1310/tsr2001-52.


Background: Participation is a multidimensional concept, consisting of an objective and a subjective dimension. Many studies have focused on determinants of only 1 dimension of participation post stroke.

Objective: To describe participation (both objective and subjective) and to determine how physical and cognitive independence and subjective complaints (pain, fatigue, and mood) influence participation in community-dwelling stroke survivors in the Netherlands.

Methods: The Utrecht Scale for Evaluation of Rehabilitation (USER) measures physical and cognitive independence and subjective complaints. USER-Participation measures 3 dimensions of participation: frequency (objective perspective), restrictions (subjective perspective), and satisfaction (subjective perspective). Spearman correlations and backward linear regression analyses were used to analyze associations between the 3 USER-Participation scores with demographics, stroke characteristics, physical and cognitive independence, and subjective complaints.

Results: Of the 111 participants, 48.5% returned to work post stroke, but mostly for only 1 to 16 hours a week. Experienced participation restrictions were most prevalent in physical exercise, chores in/around the house, housekeeping, and outdoor activities. On average, participants were relatively satisfied with their participation, but dissatisfaction occurred in cognition, activities outdoors, and work/housekeeping. Regression analysis revealed that objective participation was determined by physical and cognitive independence, age, and education, whereas subjective participation was determined by physical and cognitive independence, fatigue, and mood.

Conclusions: Most participants experienced participation problems, despite relatively good physical recovery. In addition to physical and cognitive factors, subjective complaints of persons with stroke should be addressed in the rehabilitation program.

Publication types

  • Multicenter Study

MeSH terms

  • Activities of Daily Living / psychology*
  • Chronic Disease
  • Cognition Disorders / etiology
  • Disability Evaluation
  • Fatigue / etiology
  • Female
  • Humans
  • Male
  • Mood Disorders / etiology
  • Motor Activity
  • Netherlands / epidemiology
  • Patient Participation*
  • Personal Satisfaction*
  • Residence Characteristics
  • Self Report
  • Stroke / complications
  • Stroke / epidemiology
  • Stroke / psychology*
  • Stroke Rehabilitation*
  • Survivors