Rehabilitation Interventions for Improving Social Participation After Stroke

I bet alcohol would be an excellent intervention for improving social participation. And as a bonus you get to practice your balance skills under challenging circumstances. Don't listen to anything I have to say, socially I am well recovered, physically I'm not.
Nihilism is as good as term as any to explain why our fucking failures of stroke associations do nothing to solve any of the problems in stroke for survivors.
This is pretty much fucking useless since the interventions are never described and you can't create a stroke protocol out of any of this.
http://nnr.sagepub.com/content/30/4/384.full

1. Adebimpe O. Obembe, PhD1
2. Janice J. Eng, PhD1⇑

1. ¹University of British Columbia, Vancouver, BC, Canada

1. Janice J. Eng, PhD, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, T325-2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada. Email: janice.eng@ubc.ca

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Abstract

Background. Despite the fact that social participation is considered a pivotal outcome of a successful recovery after stroke, there has been little attention on the impact of activities and services on this important domain.  

Objective. To present a systematic review and meta-analysis from randomized controlled trials (RCTs) on the effects of rehabilitation interventions on social participation after stroke.  

Methods. A total of 8 electronic databases were searched for relevant RCTs that evaluated the effects of an intervention on the outcome of social participation after stroke. Reference lists of selected articles were hand searched to identify further relevant studies. The methodological quality of the studies was assessed using the Physiotherapy Evidence Database Scale. Standardized mean differences (SMDs) and confidence intervals (CIs) were estimated using fixed- and random-effect models.  

Results. In all, 24 RCTs involving 2042 stroke survivors were identified and reviewed, and 21 were included in the meta-analysis. There was a small beneficial effect of interventions that utilized exercise on social participation (10 studies; SMD = 0.43; 95% CI = 0.09, 0.78; P = .01) immediately after the program ended. Exercise in combination with other interventions (13 studies; SMD = 0.34; 95% CI = 0.10, 0.58; P = .006) also resulted in beneficial effects. No significant effect was observed for interventions that involved support services over 9 studies (SMD = 0.09 [95% CI = −0.04, 0.21]; I² = 0%; P = .16).  

Conclusions. The included studies provide evidence that rehabilitation interventions may be effective in improving social participation after stroke, especially if exercise is one of the components.

Introduction

A World Health Organization¹ report revealed that stroke results in the greatest burden of disease among all neurological disorders (including Alzheimer’s and dementias). There is an increasing number of strokes because the North American population is aging, and a greater proportion of people than before are surviving stroke. Unfortunately, not all patients are getting access to the care and rehabilitation they need to have the best possible outcome.²

Recovery of function in stroke patients is a complex process, which may be spontaneous and involve the effects of therapeutic interventions.^3,4 Knowledge about interventions that promote the best outcomes on recovery may help optimize health care services. Successful recovery from a stroke should result in a quality of life and degree of participation in the community similar to that prior to the stroke event. There has been increasing criticism of the lack of services and research on the long-term consequences after stroke. A BMJ commentary summarized this sentiment: “Comprehensive national audits of stroke care show alarming levels of neglect in terms of chronic disease management and seem to indicate a collective nihilism about the potential for altering function and well-being after the early treatment of stroke” (p 461).⁵ However, there is little consensus about the effects of rehabilitation services for stroke survivors once they have left the hospital and are living in the community. Social participation is considered one of the most relevant and pivotal outcomes of a successful recovery.⁶ Individuals have been shown to be dissatisfied with their ability to engage in numerous aspects of participation, including socializing, outings, and travel, at 3 months after sustaining a stroke.⁷ The provision of rehabilitation services after hospital discharge may be particularly relevant because it aims to promote patients’ independence and reintegration into the community.

The International Classification of Functioning, Disability and Health (ICF) defines participation as “involvement in a life situation”⁸ or as “the lived experience” of people in the actual context in which they live. Participation is a treatment goal in the context of recovering from stroke and is known to correlate with domains related to quality of life.⁹ Using a content analysis involving 43 studies, Levasseur et al¹⁰ defined social participation “as a person’s involvement in activities that provide interaction with others in society or the community” (p 2148). Similarly, the Disability Creation Process conceptual model defines social participation as a means of carrying out one’s life habits in one’s environment (eg, school, work place, neighborhood,bar?).¹¹

Despite the fact that social participation is critical to the success of community reintegration, the literature in this area has not been systematically collated and synthesized previously, to our knowledge. Therefore, we performed a systematic review and meta-analysis to determine if rehabilitation interventions improve social participation among stroke survivors based on the evidence from randomized controlled trials (RCTs). 

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