Satisfaction with activity and participation in patients with stroke

(eng) Stroke is the most common cause of severe adult disability in the western world (Greenwood et al. 2009) and a major health problem all over the world (Kendall et al. 2007; Proot et al. 2002; Wade et al. 1987; Yu-Ying et al. 2002). In Belgium, the incidence of stroke is estimated at 2.62 per 1000 persons (Buntinx et al. 2002). Stroke may affect the social roles of the patient and it is therefore important to take into account the concept of social participation and the environmental and personal factors which may facilitate or hinder the fulfillment of the patients’ social roles (Clarke et al. 1999). In the last decade, the International Classification of Functioning, Disability and Health (ICF, 2001) model, developed by the WHO (World Health Organization 2001) shows the interaction of personal factors (e.g. age, gender, education) and environmental factors (e.g. physical, social, attitudinal obstacles/facilitators) and their impact on body functions/structures, activities, and participation. Therefore, to understand the patient’s functioning in addition of the three dimensions of the ICF model, it is important to take into account that the person requires autonomy to execute activities in real-life situations. Few tools have been developed to measure the participation domain of the ICF. Similarly, few tools allow the measurement of satisfaction. The concept of satisfaction corresponds to the person’s own perspective on his or her performance in activities and life situations that meet his or her needs and should not necessarily be related to the difficulty in the performing of the activity or the life situation. Because satisfaction is subjective, the patient’s self-report has been described as a valid measure and can be measured by eliciting the patient’s perceived satisfaction with life situations using a questionnaire with ordered categories. The main purposes of the present work are (1) to develop a new scale, based on the Rasch model, for measuring patients’ satisfaction with activity and participation in stroke patients, (2) to investigate the responsiveness of this scale, (3) to study the relationship over time between body functions and activity with perceived satisfaction of activity and participation. The present research stress the importance of considering and measuring satisfaction per se. Satisfaction with activity and participation seems to represent an interesting perspective in a long term rehabilitation program and probably reflects how the patients experience their activity limitations and participation restrictions. However, the process is complex and satisfaction is not simply the integration of body functions and activities. Indeed, satisfaction cannot simply be inferred from body functions and activities as it depends on complex interactions between functional, personal and environmental factors.