Mary Egan1, Christopher G Davis2, Claire-Jehanne Dubouloz3, Dorothy Kessler3, Lucy-Ann Kubina3. 1. School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada. Electronic address: megan@uottawa.ca. 2. Department of Psychology, Carleton University, Ottawa, ON, Canada. 3. School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada.
Abstract
OBJECTIVE: To explore reciprocal effects between participation and emotional and physical well-being during the first 2 years poststroke. DESIGN: Prospective cohort study. SETTING: Community. PARTICIPANTS: An inception cohort of adults (N=67) who had been discharged from an acute stroke unit or stroke rehabilitation unit after a first stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participation (Reintegration to Normal Living Index), emotional well-being (General Well-being Schedule), and physical well-being (General Self-rating of Health Question) were measured at 6, 9, 12, 18, and 24 months poststroke. Hierarchical linear modeling was used to examine the association between participation and change in well-being, controlling for sex, age, impairment (discharge FIM), and median neighborhood income. RESULTS: Greater engagement in valued activities was significantly associated with subsequent improvement in emotional well-being. The effect of participation on change in physical well-being was marginal. Higher levels of well-being also predicted subsequent increases in participation, with emotional well-being effects moderated by income, and physical well-being effects moderated by level of impairment. CONCLUSIONS: Our results support a 2-pronged approach to addressing well-being poststroke where efforts to improve affect and boost participation are simultaneously applied.
OBJECTIVE: To explore reciprocal effects between participation and emotional and physical well-being during the first 2 years poststroke. DESIGN: Prospective cohort study. SETTING: Community. PARTICIPANTS: An inception cohort of adults (N=67) who had been discharged from an acute stroke unit or stroke rehabilitation unit after a first stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participation (Reintegration to Normal Living Index), emotional well-being (General Well-being Schedule), and physical well-being (General Self-rating of Health Question) were measured at 6, 9, 12, 18, and 24 months poststroke. Hierarchical linear modeling was used to examine the association between participation and change in well-being, controlling for sex, age, impairment (discharge FIM), and median neighborhood income. RESULTS: Greater engagement in valued activities was significantly associated with subsequent improvement in emotional well-being. The effect of participation on change in physical well-being was marginal. Higher levels of well-being also predicted subsequent increases in participation, with emotional well-being effects moderated by income, and physical well-being effects moderated by level of impairment. CONCLUSIONS: Our results support a 2-pronged approach to addressing well-being poststroke where efforts to improve affect and boost participation are simultaneously applied.
Keywords:
GHQ; GWB; General Self-rating of Health Question; General Well-being Schedule; Health; Human activities; ICC; ICF; International Classification of Functioning, Disability and Health; Longitudinal studies; RNLI; Rehabilitation; Reintegration to Normal Living Index; Stroke; intraclass correlation coefficient
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