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Functional-level analysis of post-stroke social participation: A nationwide cohort study using the ICF framework
Jinhee Choi1, Junhee Han2, Hae In Lee3
1Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Plos One
|July 23, 2026
Summary
Social participation after stroke depends on functional level. Environmental factors are key for severe stroke survivors, while higher-functioning individuals are more impacted by body function and participation barriers. Tailored rehabilitation is crucial.
Area of Science:
- Neurorehabilitation
- Social Sciences
- Public Health
Background:
- Social participation is a critical rehabilitation goal post-stroke.
- Influencing factors for social participation are often dependent on an individual's functional status.
- Large-scale studies analyzing these factors using the International Classification of Functioning, Disability and Health (ICF) framework, stratified by functional level, are limited.
Purpose of the Study:
- To identify the determinants of social participation 12 months after stroke.
- To stratify these determinants based on the patient's functional level post-stroke.
Main Methods:
- A cross-sectional analysis of 2,695 Korean stroke survivors was performed.
- Participants were categorized into five functional groups using Fugl-Meyer Assessment (FMA) scores.
- Multivariate regression analyses examined predictors across four ICF domains (personal factors, body functions/structures, activities/participation, environmental factors) within each functional group.
Main Results:
- Determinants of social participation significantly varied across functional levels.
- For severe stroke survivors (FMA < 50), environmental factors like home accessibility and caregiver characteristics were primary.
- For higher-functioning groups (FMA ≥ 85), body functions/structures (cognitive, language, psychosocial) and activities/participation (vocational status) were more influential. Functional independence and quality of life consistently predicted participation, while caregiver burden presented a universal barrier.
Conclusions:
- Stroke rehabilitation strategies must be tailored to individual functional levels.
- Lower-functioning individuals require interventions addressing environmental barriers.
- Higher-functioning individuals benefit from interventions targeting body function, structure, and participation-related barriers.