Longitudinal changes in activity participation in the first year post-stroke and association with depressive symptoms

Research question: 1. Does activity participation improve over time in the first year after stroke? 2. What is the association of depressive symptoms on retained activity participation 12-months post-stroke adjusting for neurological stroke severity and age? 3. Is an improvement in activity participation associated with a decrease in depressive symptoms between 3- and 12-months post-stroke? Design: Longitudinal observational study of activity participation and depressive symptoms in ischemic stroke survivors. Participants: A total of 100 stroke survivors with mild neurological stroke severity. Methods: A total of 100 stroke survivors were recruited from five metropolitan hospitals and assessed at 3- and 12-months post-stroke using measures of activity participation (Activity Card Sort-Australia (ACS-Aus)) and depressive symptoms (Montgomery-Asberg Depression Rating Scale Structured Interview Guide (MADRS-SIGMA)). Results: There was a significant association between time (pre-stroke to 3-months post-stroke) and current activity participation (-5.2 activities 95% CI -6.8 to -3.5, p < 0.01) and time (pre-stroke to 12-months) and current activity participation (-2.1 activities 95% CI -3.7 to -0.5, p = 0.01). At 12-months post-stroke, a one-point increase in depressive symptoms was associated with a median decrease of 0.3% (95% CI -1.4% to -0.1%, p = 0.02) of retained overall activity participation, assuming similar neurological stroke severity and age. A decrease in depressive symptoms between 3- and 12-months post-stroke was associated with an improvement of 0.31 (95% CI -0.5 to -0.1, p = 0.01) in current activity participation. Conclusions: Activity participation improves during the first year of recovery post-stroke in stroke survivors with mild neurological stroke severity and is associated with depressive symptoms over time and at 12-months post-stroke. Implications for rehabilitation Improvements in participation occur in the first 3-months post-stroke and continue to a lesser degree in the first year after stroke. Depressive symptoms are associated with lower participation at 12-months. A multidimensional approach targeting depressive symptoms and increasing participation in the early months post-stroke and throughout the first-year after stroke is recommended to increase overall recovery following stroke. A focus on increasing leisure activity participation is recommended to improve depressive symptoms.