Do stroke survivors agree with their clinicians on the extent of their post-stroke activity limitation and participation restriction?

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Abstract

This study aimed to examine discrepancies in the reporting of post-stroke functioning between stroke survivors and their clinicians across various disability domains and across current and predicted functioning. Fifty sub-acute stroke survivors (Age M = 70.30 SD = 15.80, 56% female) and their occupational therapist independently completed three measures assessing activity limitations (cognitive, physical, instrumental) and participation restrictions. Assessments were made of current functioning and predicted functioning at three months’ post-discharge. Compared to physical functioning, appraisal discrepancies were more pronounced for cognitive functioning, instrumental activity limitation, and participation restriction. Discrepancies were more pronounced for current, as opposed to predicted, cognitive functioning (Z = −4.21, p < .001) and instrumental activity limitation (Z = −4.00, p < .001). Conversely, discrepancies in participation restriction were greatest for predicted functioning (Z = −4.03, p < .001). Follow-up (n = 39) showed that, compared to survivors’ predictions, clinicians’ predictions were more closely aligned with actual stroke survivor functioning at three months’ post-discharge (as rated by a close other). These findings suggest appraisal discrepancy varies across disability domains and time reference points, with cognitive and complex functional activities being particularly discrepant between stroke survivors and clinicians. Furthermore, clinicians may hold more realistic expectations of short-term functional recovery.
Original languageEnglish
Number of pages19
JournalNeuropsychological Rehabilitation
DOIs
Publication statusAccepted/In press - 15 Mar 2019

Keywords

  • awareness
  • insight
  • stroke
  • rehabilitation
  • disability

Cite this

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title = "Do stroke survivors agree with their clinicians on the extent of their post-stroke activity limitation and participation restriction?",
abstract = "This study aimed to examine discrepancies in the reporting of post-stroke functioning between stroke survivors and their clinicians across various disability domains and across current and predicted functioning. Fifty sub-acute stroke survivors (Age M = 70.30 SD = 15.80, 56{\%} female) and their occupational therapist independently completed three measures assessing activity limitations (cognitive, physical, instrumental) and participation restrictions. Assessments were made of current functioning and predicted functioning at three months’ post-discharge. Compared to physical functioning, appraisal discrepancies were more pronounced for cognitive functioning, instrumental activity limitation, and participation restriction. Discrepancies were more pronounced for current, as opposed to predicted, cognitive functioning (Z = −4.21, p < .001) and instrumental activity limitation (Z = −4.00, p < .001). Conversely, discrepancies in participation restriction were greatest for predicted functioning (Z = −4.03, p < .001). Follow-up (n = 39) showed that, compared to survivors’ predictions, clinicians’ predictions were more closely aligned with actual stroke survivor functioning at three months’ post-discharge (as rated by a close other). These findings suggest appraisal discrepancy varies across disability domains and time reference points, with cognitive and complex functional activities being particularly discrepant between stroke survivors and clinicians. Furthermore, clinicians may hold more realistic expectations of short-term functional recovery.",
keywords = "awareness, insight, stroke, rehabilitation, disability",
author = "Cameron, {Kate V.} and Ponsford, {Jennie L.} and Stolwyk, {Renerus J.}",
year = "2019",
month = "3",
day = "15",
doi = "10.1080/09602011.2019.1586734",
language = "English",
journal = "Neuropsychological Rehabilitation",
issn = "0960-2011",
publisher = "Taylor & Francis",

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T1 - Do stroke survivors agree with their clinicians on the extent of their post-stroke activity limitation and participation restriction?

AU - Cameron, Kate V.

AU - Ponsford, Jennie L.

AU - Stolwyk, Renerus J.

PY - 2019/3/15

Y1 - 2019/3/15

N2 - This study aimed to examine discrepancies in the reporting of post-stroke functioning between stroke survivors and their clinicians across various disability domains and across current and predicted functioning. Fifty sub-acute stroke survivors (Age M = 70.30 SD = 15.80, 56% female) and their occupational therapist independently completed three measures assessing activity limitations (cognitive, physical, instrumental) and participation restrictions. Assessments were made of current functioning and predicted functioning at three months’ post-discharge. Compared to physical functioning, appraisal discrepancies were more pronounced for cognitive functioning, instrumental activity limitation, and participation restriction. Discrepancies were more pronounced for current, as opposed to predicted, cognitive functioning (Z = −4.21, p < .001) and instrumental activity limitation (Z = −4.00, p < .001). Conversely, discrepancies in participation restriction were greatest for predicted functioning (Z = −4.03, p < .001). Follow-up (n = 39) showed that, compared to survivors’ predictions, clinicians’ predictions were more closely aligned with actual stroke survivor functioning at three months’ post-discharge (as rated by a close other). These findings suggest appraisal discrepancy varies across disability domains and time reference points, with cognitive and complex functional activities being particularly discrepant between stroke survivors and clinicians. Furthermore, clinicians may hold more realistic expectations of short-term functional recovery.

AB - This study aimed to examine discrepancies in the reporting of post-stroke functioning between stroke survivors and their clinicians across various disability domains and across current and predicted functioning. Fifty sub-acute stroke survivors (Age M = 70.30 SD = 15.80, 56% female) and their occupational therapist independently completed three measures assessing activity limitations (cognitive, physical, instrumental) and participation restrictions. Assessments were made of current functioning and predicted functioning at three months’ post-discharge. Compared to physical functioning, appraisal discrepancies were more pronounced for cognitive functioning, instrumental activity limitation, and participation restriction. Discrepancies were more pronounced for current, as opposed to predicted, cognitive functioning (Z = −4.21, p < .001) and instrumental activity limitation (Z = −4.00, p < .001). Conversely, discrepancies in participation restriction were greatest for predicted functioning (Z = −4.03, p < .001). Follow-up (n = 39) showed that, compared to survivors’ predictions, clinicians’ predictions were more closely aligned with actual stroke survivor functioning at three months’ post-discharge (as rated by a close other). These findings suggest appraisal discrepancy varies across disability domains and time reference points, with cognitive and complex functional activities being particularly discrepant between stroke survivors and clinicians. Furthermore, clinicians may hold more realistic expectations of short-term functional recovery.

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KW - insight

KW - stroke

KW - rehabilitation

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