The purpose of this study was to reflect on functioning and contextual factors among community-dwelling stroke survivors 1-2 years after first stroke and compare to their outcomes five years later. Additionally, the study sought to identify prognostic determinants influencing long-term functioning. These insights can enhance rehabilitation strategies for chronic stroke survivors and provide valuable information for survivors and their families regarding expected functional trajectories.
A national cross-sectional study on community-dwelling stroke survivors was conducted in Iceland in 2018 with a follow-up in 2023. The participants (18+ years old) were admitted to the two primary hospitals in Iceland between April 1st, 2016, and to March 30th, 2017, with a stroke diagnosis (ICD I60-I64). Surveys were mailed with five years interval (n=203 in 2018, n=114 in 2023) that included questions on contextual factors, along with the standardized Stroke Impact Scale (SIS) which is an ICF-based a standardized, stroke-specific questionnaire. SIS includes eight domains: strength, memory and thinking, emotion, communication, activities of daily living (ADL) and instrumental ADL (IADL), mobility, hand function, participation and perceived recovery. A composite physical domain was created by combining the score from the domains for strength, hand function, mobility and ADL/IADL. Descriptive analysis was used, alongside ANOVA for continuous data and Fisher´s exact tests for categorical variables.
Response rates were 56.2% in 2018 (n=114, 50% women, 71.6 ±12.9 years), and 65% in 2023 (n=56, 50% women, 73.3 ±12,4 years). In 2018, the highest score was in the communication domain (median=92.9, range 10.7-100) and the lowest score was in the emotion domain (median=63.9, range 30.6-87.5). In 2023, communication remained the domain with the highest score (median=91.1, range 35.7-100) but the lowest score was in the strength domain (median=62.5, range 12.5-100). Participants using assistive devices, those readmitted to hospital, or receiving immediate post-discharge services after their first stroke reported significantly lower SIS scores across most domains. Statistically significant changes were observed between 2018 and 2023 in the emotion domain (p=0.005) and the composite physical domain (p=0.050).
The results underscore the impact of aging on recovery trajectories in stroke survivors, highlighting the gradual decline in physical and emotional functioning over time. Furthermore, stroke survivors requiring hospitalization or using assistive devices post-stroke are more likely to experience limitations in activities and participation during the chronic phase of stroke.
Rehabilitation programs for community-dwelling stroke survivors must account for the heterogeneity of these individuals. Tailored rehabilitation approaches are essential, as a one-size-fits-all model is insufficient to address the diverse needs of stroke survivors as they age.
community-dwelling
functioning
