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Neurorehabil Neural Repair. 2018 Sep;32(9):821-833. doi: 10.1177/1545968318796341. Epub 2018 Sep 4.

Course of Social Participation in the First 2 Years After Stroke and Its Associations With Demographic and Stroke-Related Factors.

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1 Maastricht University Medical Center, Netherlands.
2 Limburg Brain Injury Center, Maastricht, Netherlands.
3 Utrecht University and De Hoogstraat Rehabilitation, Utrecht, Netherlands.
4 University of Groningen, Netherlands.
5 La Trobe University, Melbourne, Australia.
6 Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.
7 University Utrecht, Netherlands.
8 Maastricht University, Netherlands.



Many persons with stroke experience physical, cognitive, and emotional problems that contribute to restrictions in social participation. There is, however, a lack of knowledge on the long-term course of participation over time post-stroke.


To describe the time course of participation up to 2 years post-stroke and to identify which demographic and stroke-related factors are associated with this time course.


This was a multicenter, prospective cohort study following 390 persons with stroke from hospital admission up to 2 years (at 2, 6, 12, and 24 months). Multilevel modeling with linear and quadratic time effects was used to examine the course of the frequency of vocational and social/leisure activities, experienced restrictions, and satisfaction with participation.


The frequency of vocational activities increased up to 1 year post-stroke and leveled off thereafter. Older and lower-educated persons showed less favorable courses of participation than younger and higher-educated persons, respectively. The frequency of social/leisure activities decreased post-stroke. Participation restrictions declined up to 1 year post-stroke and leveled off thereafter. Persons dependent in activities of daily living (ADL) kept experiencing more restrictions throughout time than independent persons. Satisfaction with participation increased slightly over time.


Changes in participation occurred mostly in the first year post-stroke. Particularly older and lower-educated persons, and those dependent in ADL showed less favorable courses of participation up to 2 years post-stroke. Clinicians can apply these findings in identifying persons most at risk of long-term unfavorable participation outcome and, thus, target rehabilitation programs accordingly.


demography; prognosis; social participation; stroke

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