PURPOSE: Social participation is essential for stroke survivors. Although participation restrictions are affected by several factors, a few studies have focused on the effects of living in a particular residential area (urban versus rural) on the participation restrictions after a stroke. This study examined the factors affecting participation restrictions in stroke survivors according to the residential area.
METHODS: One hundred sixty-six stroke patients (including 130 living in urban areas and 36 living in rural areas) were recruited for this study. The Korean Modified Barthel Index (K-MBI) was used to assess the activities of daily living (ADL). The Korean Mini-Mental Examination Status (MMSE-K) was used to assess cognition. The motor function was evaluated using the Fugl-Meyer function assessment (FMA). Path analysis was used to test the hypothesized model of participation restriction.
RESULTS: The proposed path model showed good fit indices. In rural and urban areas, the direct effects were significant between the ADL and participation restrictions (β = -.673 and -.457, respectively). For urban areas, the direct effects were significant between cognition and participation restrictions (β = -.252). In both area types, motor function and cognition had a significant direct effect on the ADL.
CONCLUSION: For urban community-dwelling stroke survivors, the ADL and cognition had direct effects on participation restrictions. For rural area stroke survivors, the ADL had direct effects on participation restrictions. Activity level exercise programs help reduce the participation restrictions. Moreover, it is essential to address cognition training to improve participation in urban communitydwelling stroke survivors.