ASSOCIATION BETWEEN DISABILITY AND THE PHYSICAL, ATTITUDINAL AND SOCIAL ENVIRONMENT IN STROKE SURVIVORS

H. Martins dos Santos¹, F. Montoro Valente Ramon¹, J.A. Pereira Bazán¹, M.E. Ferreira Bissoli¹, T. Correa Pereira Brandão¹, G. Santos Pereira¹, S.M. Silva¹

Background: Stoke is the fourth major cause of disability-adjusted life years in Brazil. According to the International Classification of Functioning, Disability and Health, the environment exerts a direct influence on human functioning and disability. However, this relation needs to be explored from several perspectives, such as the physical, attitudinal and social environment.

Purpose: Investigate the association between the environment and disability in the chronic phase of stroke.

Methods: An exploratory, descriptive, cross-sectional study was conducted with stroke survivors. The environment (facilitators and barriers) was analyzed using the Measure of the Quality of Environment. Disability and health were measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), considering the total score as well as the cognition, mobility, self-care, interpersonal relationships, life activities and participation domains. Statistical analysis involved Spearman’s correlation coefficient (rs) to identify the association between the environment and disability, considering an alpha risk of 5%.

Results: Twenty-three individuals (13 women and 10 men) were evaluated. Mean age was 52.65 ± 10.25 and mean time elapsed since the stroke event was 89 ± 67.08 months. A significant, positive correlation of moderate magnitude was found between restriction in the WHODAS participation domain and environmental barriers (rs = 0.55, p = 0.006). No association was found between environmental facilitators and disability or health after stroke.

Conclusion(s): Environmental barriers are negatively associated with social participation in stroke survivors, with greater barriers leading to greater social restriction regarding the participation domain of the WHODAS. However, the other domains related to disability and health are not associated with either environmental barriers or facilitators. Contextual characteristics related to the environment, which are often inherent to decision making in the rehabilitation process, need to be identified and considered, especially if such aspects exert as much of an influence on functioning and disability as the stroke itself.

Implications: Considering that the Classification of Functionality, Disability and Health (ICF) is a useful clinical tool in decision-making and in the biopsychosocial assessment of the population in general, the National Health Council decided to incorporate the ICF in the Unified Health System. It is considered that evaluating individuals affected by the Stroke based on the ICF model and analyzing the influence of environmental factors, will facilitate the clinical follow-up of the population affected by the stroke, the insertion of the biopsychosocial model in health care and facilitate coding of health data for this population.

Funding, acknowledgements: CAPES/PROSUP – Brazilian Federal Agency for Support and Evaluation of Graduate Education within the Ministry of Education of Brazil.

Keywords: Stroke, ICF, Environmental factors

Topic: Neurology: stroke

Did this work require ethics approval? Yes

Institution: Universidade Nove de Julho - UNINOVE

Committee: Research Ethics Committee of Nove de Julho University (CoEP-UNINOVE)

Ethics number: 14207019.4.0000.5511