Effect of a social participation redesign programme for stroke survivors: A randomised controlled trial

Stroke survivors encounter multifaceted barriers to physical, psychological, and social adaptation. Although social participation is a crucial long-term rehabilitation outcome, few interventions have addressed multi-dimensional barriers while redesigning daily lifestyles to enhance social participation.

To evaluate the effectiveness of a social participation redesign programme for stroke survivors in improving social participation and related health outcomes.

Assessor-blinded, two-arm randomised controlled trial.

Department of Neurology of a tertiary hospital in Changchun, China.

Stroke survivors aged ≥18 years with a modified Rankin Scale score <4 (N = 112).

Participants were recruited using convenience sampling and randomly assigned to either an intervention group (n = 56) or a control group (n = 56) receiving usual care. The eight-week intervention comprised WeChat-based group sessions, group activities, and individual consultations. The primary outcome was social participation frequency. Secondary outcomes were participation satisfaction and restrictions, social support, functional and cognitive status, depression, anxiety, and intrinsic motivation. Data were collected at baseline (T0), post-intervention (T1) and three months post-intervention (T2). Generalised estimating equation models were applied to examine effects of the intervention on the study outcomes. Mediation analyses were conducted to explore the potential mechanisms underlying these effects.

At T1, the intervention group demonstrated significant improvements in social participation frequency (β = 0.13, 95% CI: 0.05 to 0.20, p = 0.001). Significant improvement in social participation satisfaction (β = 0.11, 95% CI: 0.06 to 0.15, p < 0.001), social support (β = 0.08, 95% CI: 0.02 to 0.14, p = 0.005), intrinsic motivation (β = 0.10, 95% CI: 0.03 to 0.17, p = 0.003) and reductions in participation restrictions (β = 0.07, 95% CI: 0.00 to 0.13, p = 0.035), depression (β = -0.93, 95% CI: -1.68 to -0.19, p = 0.014) and anxiety (β = -0.92, 95% CI: -1.83 to -0.00, p = 0.049) was also observed. Improvements in social interaction and relationships (β = 0.09, 95% CI: 0.03 to 0.16, p = 0.007), and subjective social support (β = 0.08, 95% CI: 0.01 to 0.14, p = 0.016) were maintained at T2. Mediation analysis indicated that social support, depression, and intrinsic motivation were potential statistical mediators of the intervention effect on social participation.

The social participation redesign programme was associated with short-term improvements in social participation and psychosocial health. Social support and psychological factors may represent potential pathways associated with improvements in social participation.

This randomised controlled trial was registered in the Chinese Clinical Trial Registry (ChiCTR.org.cn; ChiCTR2400084787). Registration date: May 2024. Recruitment commenced in August 2024.