Factors Associated With Participation in Life Situations for Adults With Stroke: A Systematic Review

Objectives: To identify biopsychosocial factors associated with participation outcomes for adults with stroke and to investigate factors associated with participation at different time points poststroke. Data Sources: Medline, CINAHL, AMED, PyschINFO, and Web of Science were systematically searched using keywords stroke, participation, and outcomes and their synonyms on May 15, 2017. Study Selection: Observational studies reporting on biopsychosocial factors and participation outcomes for community-dwelling adults with stroke were selected. Studies were eligible for inclusion if participation outcomes were measured using indices that mapped to the participation domain of the International Classification of Functioning, Disability and Health (ICF). Intervention studies were excluded. A second reviewer checked all studies against eligibility criteria at each stage. Data Extraction: Data were extracted on any statistically determined association between biopsychosocial factors and participation outcomes. Data Synthesis: The proportion of studies reporting significant associations with variables was classified according to the ICF. The exact binomial test was used to determine the probability that the proportion of studies reporting significant associations was due to chance alone. Qualitative descriptive summaries of each study allowed consideration of interactions between variables and changes in participation over time points. Conclusions: Although depressive symptoms, cognitive functioning, and mobility were found to have the strongest associations with participation, we found that other frequently occurring factors (such as fatigue and environmental factors) were less extensively considered. The diversity of outcome measures encountered within the review highlight the need for a consensus on a core set of outcome measures to evaluate long-term participation in life situations poststroke. (C) 2018 by the American Congress of Rehabilitation Medicine