Grant: CIHR Fellowship

Stroke is a leading cause of long-term disability in adults. Subsequently stroke survivors are often left with physical impairments that limit their ability to do every day activities of daily living. Community reintegration is the return to participating in meaningful activities of daily living, community interests and life roles and is one of the most important elements of stroke rehabilitation. Physical and cognitive impairments have immense impact on reintegration of stroke patients. Community rehabilitation services are costly, and it is not known whether such services benefit community reintegration, or could potentially reduce the usage and cost of other health and social services. The primary purpose of this study is to determine the influence of community rehabilitation services on community reintegration. Methods: This study will use a 12-month longitudinal study design. One hundred community-dwelling patients with first stroke of three months duration or less and their caregivers will be recruited for this study. Subjects will be assessed at 3 months (considered sub-acute stroke) and 15 months post-stroke (considered chronic stroke). Community-reintegration will be measured by the Reintegration to Normal Living Index, as well by the Caregiver Strain Index. The Health and Social Service Utilization Inventory will be used to track and determine the extent of the use and cost of health and social services. We will also assess impairments (walking ability, balance ability, depressive symptoms, fatigue, cognition). Our analysis will determine whether community rehabilitation services (in terms of hours and number of different services) influence community reintegration after stroke. Clinical implications: This study will provide the first data to determine the impact of community rehabilitation services on community reintegration, as well as health care utilization and costs; and have significant implications for the clinical practice of stroke rehabilitation