1. 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 220020087, 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 1212 54 56 64.2 SD 13.4 60.5 SD 12.8 0.14 Education (years) 1212 54 56 12.8 SD 3.1 13.2 SD 2.7 0.47 NIHSS Total 1212 54 56 2.4 SD 1.6 2.2 SD 1.4 0.51 Barthel Total 1212 54 55 98.9 SD 4.0 98.8 SD 5.1 0.94 Modified Rankin 1212 51 49 0.22 SD 0.54 0.18 SD 0.49 0.76 GroupNMaleFemalep value (α=.05) Gender 1212 54 56 28 31 26 25 0.71 WhiteNon-White Race 1212 54 56 29 36 25 20 0.26 Demographics and Acute Measures Compared based on % Retained HDL Activities after Mild Stroke GroupNMean SDp value * SIS Perceived Recovery 1212 53 55 75.3 SD 17.9 86.4 SD 16.1 0.001 SIS Strength Domain 1212 53 55 71.2 SD 22.1 85.5 SD 19.1 0.001 SIS Memory & Thinking Domain 1212 53 55 83.7 SD 14.3 89.9 SD 14.5 0.026 SIS Emotion Domain 1212 52 55 61.8 SD 10.2 63.2 SD 11.6 0.517 SIS Communication Domain 1212 53 55 89.6 SD 12.8 92.6 SD 13.3 0.238 SIS ADL/IADL Domain 1212 53 55 87.2 SD 14.0 93.3 SD 10.1 0.011 SIS Mobility Domain 1212 52 54 78.3 SD 17.0 89.5 SD 16.4 0.001 SIS Hand Function Domain 1212 53 55 80.8 SD 24.7 89.6 SD 19.6 0.04 SIS Participation & Role Function Domain 1212 53 54 74.7 SD 21.5 92.2 SD 15.1 0.00 Clients’ Perceived Recovery after Mild Stroke Compared between Groups based on the SIS VariableOdds Ratio95% Confidence Intervalp value (α=.05) SIS Total Perceived Recovery 1.0271.000-1.0560.05 SIS Strength Domain Score1.0331.007-1.0610.01 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%