Participation And Its Influencing Factors Of First-stroke Patients: A6-month Longitudinal Study

Objective:The aim of this study was to explore and describe first-stroke patients’social participation and its influencing factors in different time points within6months after discharge, and to analyze its trajectory, explore the main influencing factors of participation at various stages. Explored the factors which can be controlled by the nurses.And to provide the theory basis for targeted intervention, promote the patients to fully participate in social life, eventually improve the quality of life of patients.Methods:A prospective longitudinal design was used in this study.271first-stroke patients were recruited in a Three Level Hospital between December2011and December2012.We investigated the participation and its predictors of these patients by questionnaires door to door at three time points in6months.The three time points were:1week after discharge (Ti),3months after discharge(T2),6months after discharge(T3).Under the framework of ICF model, We used Chinese Stroke Scale (CSS), Barthel index (BI), Chinese version of Impact on Participation and Autonomy Questionaire (IPA-C) measured body structure and function, activity, participation. Using general data questionnaire, hospital anxiety depression scale(HAD), social support rating scale(SSS) to investigate patients’ general information, mental health, social support.SPSS17.0was adopted to establish database and analysis.Using T-test, ANOVA, Mann-Whitney U test, Kruskal-Wallis H test, Pearson correlation analysis, Spearman correlation analysis, Multiple linear regression analysis, Repeated measurement analysis.Results:249patients finally completed the whole procedure, with7patients died and15missed during the follow up.①At Ti, IPA score of first-stroke patients was61.14±13.44, the average scores of each dimension in descending order were as the following:family role (3.10±0.72), indoor autonomy (3.04±0.51), outdoor autonomy (2.04±0.70), social life (1.66±0.92);②At T2, IPA score was51.38±14.45,the average scores of each dimension in descending order were as the following:outdoor autonomy (2.66±0.56), family role (2.58±0.69), social life (1.85±0.56), indoor autonomy(1.28±0.79);③At T3, IPA score was41.52±16.18,the average scores of each dimension in descending order were as the following:outdoor autonomy (2.26±0.77), family role (2.08±0.78),social life (1.81±0.66), indoor autonomy (0.68±0.79).①The scores of IP A in T1,T2,T3were downtrend (p=0.000).The score lower,the participation higher. So the level of participation is uptrend.②There are two stages in T1to T3. The first stage:the IPA score between T1and T2was9.52±7.99; The second stage, the IPA score between T2and T3was9.65±8.53.①Multiple linear regression analysis, at T1, it identified the influential variables of social participation were:activities(BI), anxiety, social support,the time interval between onset to admission, which explain59.5%of variance.②At T2, It identified the influential variables of social participation were:activities(BI), anxiety, sequela and care type, explain71.2%of variance.③At T3, It identified the influential variables of social participation were:physical function (CSS), depression, economic status, activities(BI), sequela, explain73.3%of variance.④Repeated measurement analysis indicated that the participation were different along with the change of time(p=0.000). There were differences between groups (p<0.05)of age, marital status, employment status,dwelling condition,care type,chronic disease,the time interval between onset to admission,disease knowledge,interval between discharge to rehabilitation,sequel. Interaction was found between time and group (p<0.05) of level of education,types of stroke,rehabilitation or not, re-onset or not.②Multiple linear regression analysis indicated that CSS score difference, anxiety score difference,BI score difference, Using support score difference entered the regression equation at two stages.Conclusion:The findings of this study demonstrated that the first stroke survivors have restriction in participation.when discharged from hospital1week later, the restriction of family roles is the largest.when discharged from hospital3months and6months, the restriction of outdoor autonomy is the largest. According to it, we should take corresponding measures.The participation in T1,T2,T3were uptrend. The difference of CSS score,anxiety score,BI score,Using support score affect participation at two stages.At T1,T2,T3, the common influential variables of participation were:activities (BI), anxiety or depression, and they continued affecting rehabilitation process of patients. So that we should be aimed to improve daily life activities ability and psychological state of patients, and the environmental factors should not be neglected. It is important to provide rehabilitation based on the individuals’needs at different stages when planning appropriate rehabilitation interventions, finally improve the QOL of first-stroke patients.