Mobility, functional balance and dependence on functionality in hospital discharge as predictors of social participation in the community after cerebrovascular accident.

Abstract

Introduction: Cerebrovascular accident (CVA) is the leading cause of death and disability in Brazil, and its prognostic indicators of social reintegration are not well established yet. Mapping possible predictors of restrictions on social participation after stroke in the community can be an important tool to support the development of rehabilitation strategies even in a hospital environment. Objective: To identify deficiencies in structure and function and limitations in activity that predict restrictions on post-stroke social participation in the community (Article 1). Identify whether mobility, functional balance and the dependence on functionality at hospital discharge are capable of predicting restrictions on social participation one year after a stroke in the community (article 2). Method: This study aimed to investigate the theme through two methodological designs. Initially, a systematic review was carried out (article 1), selecting prospective and/or retrospective cohort studies that investigated deficits in structure and function and/or activity limitations, as predictors of social participation, in post-stroke individuals in the community. In this review, we excluded studies involving subarachnoid hemorrhage, as well as other neurological diseases, and participants in long-term care facilities. The Newcastle-Ottawa quality assessment scale was used to assess methodological quality, and the results were synthesized according to the exposures found, considering the statistical models used (article 1). Subsequently, a hospital-based dynamic concurrent cohort study was conducted (article 2). Individuals over 18 years of age with a diagnosis of acute stroke were included. Patients with dementia, previous functional limitations and cancer patients were not included. Mobility, balance and functional independence were the predictor variables at hospital discharge, and the outcome of interest was social participation assessed one year after stroke in the community (article 2). Results: Article 1, included 11 articles, total 2,412 subjects, 58.4% men, 83.7% Stroke I. Seven exposures were evaluated across studies. 10 studies assessed body structure and function exposures (stroke severity, cognitive, executive, emotional and motor function) and 8 studies assessed activity exposures (activity of daily living and ability to walk). Article 2, 48 patients included in the analysis after a one-year follow-up. The degree of functional independence at hospital discharge (b = 0.813; p <0.01) was an independent predictor of social participation, specifically locomotion (B = 0.452; p <0.001) and related social cognition (B = 0.462; p <0.001) to functional independence. Mobility (b = 0.040; p 0.777) and functional balance (b = 0.060; p 0.652) did not show an independent association. Cognitive functional independence was a predictor of daily activities (B = 0.786; p <0.001), social roles (B = 0.390; p = 0.014) and satisfaction (B = 0.564; p <0.001) of social participation. Conclusion: There is some evidence that stroke severity, mental and motor deficits, activities of daily life limitations and post-stroke walking ability can predict social participation in the community. Specifically, the degree of functional independence after stroke at hospital discharge was able to predict social participation in the community one year after the stroke.