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Qual Life Res. 2014 Feb;23(1):39-47. doi: 10.1007/s11136-013-0441-6. Epub 2013 Jun 11.

Necessary and sufficient causes of participation post-stroke: practical and philosophical perspectives.

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James McGill Professor, Division of Clinical Epidemiology, Department of Medicine, McGill University Health Center, Royal Victoria Hospital Site, Ross Pavilion R4.29, 687 Pine Ave W, Montreal, QC, H3A 1A1, Canada,



Participation, a construct within the disability/functioning framework, is evaluated on a person's involvement in life situations including family, community, work, social, and civic life. In the context of recovering from a major health event, participation is a treatment goal and it is known to correlate with the quality of life.


The purpose of this study is to track the dynamics of participation post-stroke in relationship to the dynamics of walking capacity, social support, and mood.


An inception cohort was followed over the first post-stroke year. Group-based trajectory analysis, a form of latent class analysis, was used to identify distinctive groups of individuals with similar trajectories. Dual trajectories were used to estimate concordance between participation trajectory and trajectories for each of the three constructs under study.


From the sample of 102 persons (mean age 70), four trajectories of participation were identified, two of which were qualified as excellent and very good, and two qualified as fair and poor. All those with excellent walking showed excellent participation. However, people with excellent (and very good) community participation had a range of walking capacities. Most (82%) people with normal mood showed excellent participation. People with good mood but not meeting norms for age showed the complete range of participation trajectories from excellent to poor. The higher proportion of people with excellent or good social support (57%) showed excellent participation.


Two treatable component causes of participation, walking capacity and mood, were identified; of these, only excellent walking capacity could be considered a sufficient cause.

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