Perceived Recovery as a Predictor of Physical Activity after Mild Stroke Jessica Koster, BA, MSOTS 1, & Timothy J. Wolf, OTD, MSCI, OTR/L 1,2 Washington University School of Medicine: 1 Program in Occupational Therapy, 2 Department of Neurology Background & Purpose The Stroke Population  795,000 people experience a stroke each year and it’s the #1 cause of serious, long-term disability in the U.S. (Centers for Disease Control, 2001)  Total Cost of stroke in 2007 = $40.9 billion more than any other diagnostic group (American Heart Association, 2011 )  Changing Demographics of the Stroke Population (Wolf, Baum, & Connor, 2009) →Decreasing average age of stroke onset →Decreasing neurological severity level of stroke Participation in Physical Activity  Research shows an overriding decrease in levels of physical activity post-mild stroke →Estimated 25% or more of pre-stroke high-demand leisure (HDL) activities are lost (Hildebrand, Brewer, & Wolf, 2012)  Very limited awareness on the link between stroke and decreased physical activity (Muller-Nordhorn et al., 2006)  Yet, research demonstrates clear physical and psychosocial benefits to the inclusion of physical activity in stroke rehabilitation (Duncan et al., 2003; Harrington et al., 2010; Studenski et al., 2005; Tang et al., 2009)  There is little known on factors limiting participation in physical activity after mild stroke (Baseman et al., 2010; Roth et al., 1998; Roth & Lovell, 2003) →Past studies suggest it is not factors relating to neurological impairments Research Objective: The Purpose of this study was to identify what acute variables and/or perceived recovery factors could predict decreased participation in physical activities post-mild stroke. Method Acute Care Measures:  National Institutes of Health Stroke Scale (NIHSS) →Measures neurologic impairment at time of person’s stroke with scores ranging from 0 (no deficit) to 42 (severe neurologic deficit)  Barthel Index →Used to determine baseline of functioning by assessing 10 activities of daily living and mobility. Score is based on the amount of help received.  Modified Rankin Scale →Categorizes people based on self-report of pre-stroke level of functional independence. Perceived Recovery Measures:  Stroke Impact Scale (SIS) →Self-report questionnaire with 8 domains (rated on 5-point likert scale) and an overall perceived recovery rating (0 = no recovery, 100 = full recovery)  Activity Card Sort (ACS): High-demand leisure category →Includes 17 activities with higher-levels of cardiovascular expenditure →i.e., running, walking, bicycling, and gardening Acknowledgments We acknowledge the James S. McDonnell Foundation (Grant , Carolyn Baum, PI) for the support of this study. Special thanks to Dr. Wolf and to all the members of the Cognitive Rehabilitation Research Group. Results Method Methods: Secondary Analysis of patients recruited 6-8 months post- stroke for voluntary follow-up assessments Participants : 110 patients with a mild stroke from the Acute Neurology Stroke Service of Barnes-Jewish Hospital  Additional Inclusion Criteria: Participated in 6-8 month follow-up visit, had complete data for Activity Card Sort (ACS), and had a mild stroke (NIHSS score < 6)  Sample divided into 2 groups based on % retained high-demand leisure (HDL) activities (from ACS measure) at 6 months post-stroke: Group 1: Those with 75% or less retained (N=54) Group 2: Those with more than 75% retained (N=56) Results GroupNMean SDp value (α=.05) Age SD SD Education (years) SD SD NIHSS Total SD SD Barthel Total SD SD Modified Rankin SD SD GroupNMaleFemalep value (α=.05) Gender WhiteNon-White Race Demographics and Acute Measures Compared based on % Retained HDL Activities after Mild Stroke GroupNMean SDp value * SIS Perceived Recovery SD SD SIS Strength Domain SD SD SIS Memory & Thinking Domain SD SD SIS Emotion Domain SD SD SIS Communication Domain SD SD SIS ADL/IADL Domain SD SD SIS Mobility Domain SD SD SIS Hand Function Domain SD SD SIS Participation & Role Function Domain SD SD Clients’ Perceived Recovery after Mild Stroke Compared between Groups based on the SIS VariableOdds Ratio95% Confidence Intervalp value (α=.05) SIS Total Perceived Recovery SIS Strength Domain Score Results of Logistic Regression Analysis. Variables Significantly Contributing to % Retained HDL Activities post Mild Stroke (N=96) Note: Group 1 represents those who retained 75% or less of their HDL activities post-stroke, and Group 2 represents those who retained greater than 75% * Using Bonferroni’s correction, p value significance level at α=0.006 for all SIS items Conclusions Limitations and Future Directions:  Missing data for some of the measures used in statistical analyses  Secondary analysis limited assessment and outcome measures available to analyze  Future Research should include more detailed participation measures and psychological measures Implications for Rehabilitation:  Persons with mild stroke are significantly decreasing their participation in physical activities post-stroke.  Common stroke measures from the acute care setting that are currently used in practice are not sensitive enough to predict the changes in physical activity after mild stroke.  Perceived level of recovery/limitations should be considered by clinicians in determining what barriers are affecting clients’ physical activity participation after stroke. Note: Group 1 represents those who retained 75% or less of their HDL activities post-stroke, and Group 2 represents those who retained greater than 75%