Community Integration in Long Term Stroke Survivors
The aim of the current study is to examine the level of community integration in a cohort of long-term four-year stroke survivors with the objective of understanding what factors at baseline can affect low levels of community integration. Stroke, an acute neurological deficit lasting more than 24 hours, is one of the most preventable diseases globally, with around 85% of strokes able to be prevented each year. It causes around six million deaths per year and in New Zealand, has the highest stroke prevalence rate than any other high-income country. Rehabilitation post stroke is extremely important to ensure an individual has the best chance of recovery, as around 40 percent of individuals experience some form of disability. Community integration is an important area of rehabilitation to ensure it is possible for individuals to integrate back into the community as well as possible. Community integration can be a struggle for individuals who have suffered from a stroke as there are major changes within their lives that they must navigate. There are different factors that current research has found to affect community integration levels such as good levels of social support, mobility levels and confidence yet there is still a limited number of studies that look at the long term impact of community integration on stroke and what baseline factors are related to levels of community integration. This quantitative study used previously collected data from a follow-up of participants who consented into the fourth Auckland Regional Community Outcomes Stroke study. It analysed data from 255 participants over 16 years of age living in Auckland, New Zealand. The data were collected using questionnaires at baseline and /or within two weeks after stroke and then again four years later. The community integration questionnaire, a psychometric tool used to measure community integration, was used to examine the level of community integration and was used with the baseline factors to understand which factors can predict levels of community integration. A descriptive analysis and multiple logistic regression were used to analyse the data. This analysis found that community integration was a problem for many individuals within this study, based on the cut off scores for low community integration being <14. The data analysed, using a multiple regression analysis, found there were many factors that were significant in predicting community integration. The main findings from this study were that age, employment status and education levels at baseline were found to significantly predict community integration levels four years post stroke. Several previous studies have backed up these findings, particularly the findings with age but more research is necessary to make assumptions about how well these factors can predict the likelihood of having low community integration levels. This unique New Zealand study investigated factors which influence community integration in long term stroke survivors. It highlights the importance of rehabilitation post stroke as it has shown there are many issues that individuals may struggle with post stroke that can be improved by utilising rehabilitation as soon as possible post stroke. It also highlights the lack of research in this area. To ensure these results are useful in the rehabilitation community, future research should focus more on the baseline factors that were found to be significant, which was age, education and employment status as these were shown to have a relationship with community integration levels four years post stroke.
Stroke, Community integration, ARCOS, New Zealand
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