Longitudinal changes in activity participation in the first year post-stroke and association with depressive symptoms.

Abstract

<b>Research question:</b> 1. Does activity participation improve over time in the first year after stroke? 2. What is the association of depressive symptoms on retained activity participation 12-months post-stroke adjusting for neurological stroke severity and age? 3. Is an improvement in activity participation associated with a decrease in depressive symptoms between 3- and 12-months post-stroke? <b>Design:</b> Longitudinal observational study of activity participation and depressive symptoms in ischemic stroke survivors. <b>Participants:</b> A total of 100 stroke survivors with mild neurological stroke severity. <b>Methods:</b> A total of 100 stroke survivors were recruited from five metropolitan hospitals and assessed at 3- and 12-months post-stroke using measures of activity participation (Activity Card Sort-Australia (ACS-Aus)) and depressive symptoms (Montgomery-Asberg Depression Rating Scale Structured Interview Guide (MADRS-SIGMA)). <b>Results:</b> There was a significant association between time (pre-stroke to 3-months post-stroke) and current activity participation (-5.2 activities 95% CI -6.8 to -3.5, <i>p</i> < 0.01) and time (pre-stroke to 12-months) and current activity participation (-2.1 activities 95% CI -3.7 to -0.5, <i>p</i> = 0.01). At 12-months post-stroke, a one-point increase in depressive symptoms was associated with a median decrease of 0.3% (95% CI -1.4% to -0.1%, <i>p</i> = 0.02) of retained overall activity participation, assuming similar neurological stroke severity and age. A decrease in depressive symptoms between 3- and 12-months post-stroke was associated with an improvement of 0.31 (95% CI -0.5 to -0.1, <i>p</i> = 0.01) in current activity participation. <b>Conclusions:</b> Activity participation improves during the first year of recovery post-stroke in stroke survivors with mild neurological stroke severity and is associated with depressive symptoms over time and at 12-months post-stroke. Implications for rehabilitation Improvements in participation occur in the first 3-months post-stroke and continue to a lesser degree in the first year after stroke. Depressive symptoms are associated with lower participation at 12-months. A multidimensional approach targeting depressive symptoms and increasing participation in the early months post-stroke and throughout the first-year after stroke is recommended to increase overall recovery following stroke. A focus on increasing leisure activity participation is recommended to improve depressive symptoms.