Tareq Kass-Hout, MD

Skolarus LE, Burke JF, Brown DL, and Freedman VA. Understanding Stroke Survivorship: Expanding the Concept of Poststroke Disability. Stroke. 2013

Skolarus et al. conducted a data analysis recently published online in stroke and identify a different aspect of disability post stroke that we often ignore: post-stroke participation restriction. The authors also investigate the extent to which post-stroke participation restriction is accounted for by cognitive impairment, language disorders, and/or psychiatric symptoms.

Patients, a total of 892, were from the National Health and Aging Trends Study (NHATS) database and matched with a control group based on demographics and co-morbidities. The authors defined post-stroke participation restriction as reductions/absence in social activities valued by respondents because of their health or functioning. The analysis showed that stroke survivors are two times more likely to have participation restriction (attending religious service, clubs/classes and going out for enjoyment) than the control group, this was true after adjusting for physical capacity. Also, psychiatric symptoms such as depression and anxiety, and aphasia/dysarthria were independent predictors of participation restrictions.

In short, this study is proposing a new, yet very important, post-stroke disability measure, which is participation restriction. I consider this analysis an eye opener for stroke specialist to pay extra attention aiming to minimize post-stroke disability by improving physical capacity, reducing depressive and anxiety symptoms, and improving aphasia/dysarthria.