Associations between participation and personal factors in community-dwelling adults post-stroke

Melanie Hoyle; Pamela Meredith; Tamara Ownsworth; Asaduzzaman Khan; Louise Gustafsson

doi:10.1071/IB23044

RESEARCH ARTICLE (Open Access)

Previous Next Contents Vol 24(3)

Associations between participation and personal factors in community-dwelling adults post-stroke

Melanie Hoyle

^A ^* , Pamela Meredith

^A ^B , Tamara Ownsworth

^C ^D , Asaduzzaman Khan

^A and Louise Gustafsson

^A ^D ^E

+ Author Affiliations

- Author Affiliations

^A School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia

^B School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia

^C School of Applied Psychology, Griffith University, Brisbane, Australia

^D Menzies Health Institute Queensland, Griffith University, Brisbane, Australia

^E School of Health Sciences and Social Work, Griffith University, Brisbane, Australia

^* Correspondence to: m.hoyle@uq.edu.au

Brain Impairment 24(3) 456-473 https://doi.org/10.1017/BrImp.2022.31

Submitted: 11 June 2021 Accepted: 9 October 2022 Published: 20 December 2022

© The Author(s), 2022. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To examine associations between post-stroke participation and personal factors, including demographic characteristics, self- and threat appraisals, and personality variables.

Methods:

An exploratory cross-sectional study with purpose-designed survey was completed online or via mail. The survey was comprised of demographic and health-related questions and multiple questionnaires, including the Stroke Impact Scale Version 3.0 (SISv3) (participation/perceived recovery), Community Integration Questionnaire (CIQ) (participation), Head Injury Semantic Differential III (pre- vs post-stroke self-concept/self-discrepancy), Appraisal of Threat and Avoidance Questionnaire (threat appraisal), Life Orientation Test – Revised (optimism) and Relationships Questionnaire (adult attachment style) that measured variables of interest. Sixty-two participants, aged 24–96 years who had experienced a stroke (one or multiple events) and had returned to community living, completed the survey. Associations were examined using correlations, and univariate and multiple linear regression analyses.

Results:

Regression analysis showed that greater participation, measured using the CIQ, was associated with younger age, female gender, lower self-discrepancy and higher perceived recovery, explaining 69% of the variability in CIQ participation. Further, greater participation on the SISv3 was associated with lower self-discrepancy and higher perceived recovery, explaining 64% of the variability in SISv3 participation.

Conclusions:

Results indicate that personal factors, particularly self-appraisals like self-concept/self-discrepancy, in combination with perceived recovery may be important in explaining a large portion of variance in post-stroke participation. Specifically, findings highlight the interrelatedness of self-concept change, perceived recovery and post-stroke participation. Further longitudinal research is needed to clarify the directionality of these associations throughout the hospital-to-home transition.

Keywords: cerebrovascular accident, community, participation, personal factors, recovery, self-concept, stroke.

References

Ahn, S. N., Hwang, S. (2018) An investigation of factors influencing the participation of stroke survivors in social and leisure activities. Physical Therapy Rehabilitation Science 7(2), 67-71 https://doi.org/10.14474/ptrs.2018.7.2.67.
| Google Scholar |

Andrew, N. E., Kilkenny, M., Naylor, R., Purvis, T., Lalor, E., Moloczij, N., Cadilhac, D. A. (2014) Understanding long-term unmet needs in Australian survivors of stroke. International Journal of Stroke 9(SA100), 106-112 https://doi.org/10.1111/ijs.12325.
| Google Scholar |

Bäckström, M., Holmes, B. M. (2001) Measuring adult attachment: A construct validation of two self-report instruments. Scandinavian Journal of Psychology 42, 79-86 https://doi.org/10.1111/1467-9450.00216.
| Google Scholar |

Badley, E. M. (2006). More than facilitators and barriers: Fitting the full range of environmental and personal contextual factors into the ICF model. In 12th Annual North American Collaborating Center Conference on ICF, Vancouver, British Columbia.

Bartholomew, K., Horowitz, L. M. (1991) Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology 61(2), 226-244 https://doi.org/10.1037/0022-3514.61.2.226.
| Google Scholar |

Baseman, S., Fisher, K., Ward, L., Bhattacharya, A. (2010) The relationship of physical function to social integration after stroke. Journal of Neuroscience Nursing 42(5), 237-244 https://doi.org/10.1097/JNN.0b013e3181ecafea.
| Google Scholar |

Beadle, E. J., Ownsworth, T., Fleming, J., Shum, D. H. K. (2020) The nature of occupational gaps and relationship with mood, psychosocial functioning and self-discrepancy after severe traumatic brain injury. Disability and Rehabilitation 42(10), 1414-1422 https://doi.org/10.1080/09638288.2018.1527954.
| Google Scholar |

Beadle, E. J., Ownsworth, T., Fleming, J., Shum, D. H. K. (2020) Personality characteristics and cognitive appraisals associated with self-discrepancy after severe traumatic brain injury. Neuropsychological Rehabilitation 30(3), 393-411 https://doi.org/10.1080/09602011.2018.1469416.
| Google Scholar |

Béjot, Y., Daubail, B., Jacquin, A., Durier, J., Guy-Victor, O., Rouaud, O., Giroud, M. (2014) Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: The Dijon stroke registry. Journal of Neurology, Neurosurgery and Psychiatry 85, 509-513 https://doi.org/10.1136/jnnp-2013-306203.
| Google Scholar |

Bergström, A. L., Guidetti, S., Tham, K., Eriksson, G. (2017) Association between satisfaction and participation in everyday occupations after stroke. Scandinavian Journal of Occupational Therapy 24(5), 339-348 https://doi.org/10.1080/11038128.2016.1245782.
| Google Scholar |

Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York, NY: Basic Books.

Bowlby, J. A. (1969). Attachment and loss: Attachment. New York, NY: Basic Books.

Brady, M. C., Fredrick, A., Williams, B. (2012) People with aphasia: Capacity to consent, research participation and intervention inequalities. International Journal of Stroke 8(3), 193-196 https://doi.org/10.1111/j.1747-4949.2012.00900.x.
| Google Scholar |

Brock, K., Black, S., Cotton, S., Kennedy, G., Wilson, S., Sutton, E. (2009) Goal achievement in the six months after inpatient rehabilitation for stroke. Disability Rehabilitation 31(11), 880-886 https://doi.org/10.1080/09638280802356179.
| Google Scholar |

Carey, L. M., Matyas, T. A., Baum, C. (2018) Effects of somatosensory impairment on participation after stroke. American Journal of Occupational Therapy 72, 1-10 https://doi.org/10.5014/ajot.2018.025114.
| Google Scholar |

Carod-Artal, F. J., Coral, L. F., Trizotto, D. S., Moreira, C. M. (2009) Self- and proxy-report agreement on the Stroke Impact Scale. Stroke 40(10), 3308-3314 https://doi.org/10.1161/STROKEAHA.109.558031.
| Google Scholar |

Carod-Artal, F. J., González-Gutiérrez, J. L., Egido Herrero, J. A., Horan, T., Varela de Seijas, E. (2002) Functional recovery and instrumental activities of daily living: Follow-up 1-year after treatment in a stroke unit. Brain Injury 16(3), 207-216 https://doi.org/10.1080/02699050110103337.
| Google Scholar |

Carroll, E., Coetzer, R. (2011) Identity, grief and self-awareness after traumatic brain injury. Neuropsychological Rehabilitation 21(3), 289-305 https://doi.org/10.1080/09602011.2011.555972.
| Google Scholar |

Chung, M. L., Bakas, T., Plue, L. D., Williams, L. S. (2016) Effects of self-esteem, optimism, and perceived control on depressive symptoms in stroke survivor-spouse dyads. Journal of Cardiovascular Nursing 31(2), E8-E16 https://doi.org/10.1097/JCN.0000000000000232.
| Google Scholar |

Cicero, V., Lo Coco, G., Gullo, S., Lo Verso, G. (2009) The role of attachment dimensions and perceived social support in predicting adjustment to cancer. Psycho-Oncology 18(10), 1045-1052 https://doi.org/10.1002/pon.1390.
| Google Scholar |

Ciechanowski, P., Russo, J., Katon, W., Von Korff, M., Ludman, E., Lin, E., Bush, T. (2004) Influence of patient attachment style on self-care and outcomes in diabetes. Psychosomatic Medicine 66(5), 720-728 https://doi.org/10.1097/01.psy.0000138125.59122.23.
| Google Scholar |

Corrigan, J. D., Deming, R. (1995) Psychometric characteristics of the Community Integration Questionnaire: Replication and extension. Journal of Head Trauma Rehabilitation 10(4), 41-53 https://doi.org/10.1097/00001199-199508000-00005.
| Google Scholar |

Creswell, J. W., & Plano Clark, V. L. (2011). Designing and conducting mixed methods research. Los Angeles, CA: SAGE Publications Inc.

D’Alisa, S., Baudo, S., Mauro, A., Miscio, G. (2005) How does stroke restrict participation in long-term post-stroke survivors? Acta Neurologica Scandinavica 112(3), 157-162 https://doi.org/10.1111/j.1600-0404.2005.00466.x.
| Google Scholar |

Dalemans, R. J., de Witte, L. P., Beurskens, A. J., van den Heuvel, W. J., Wade, D. T. (2010) Psychometric properties of the Community Integration Questionnaire adjusted for people with aphasia. Archives of Physical Medicine and Rehabilitation 91(3), 395-399 https://doi.org/10.1016/j.apmr.2009.10.021.
| Google Scholar |

Dijkers, M. P. (2010) Issues in the conceptualization and measurement of participation: An overview. Archives of Physical Medicine and Rehabilitation 91(9), S5-S16 https://doi.org/10.1016/j.apmr.2009.10.036.
| Google Scholar |

Dowswell, G., Lawler, J., Dowswell, T., Young, J., Forster, A., Hearn, J. (2000) Investigating recovery from stroke: A qualitative study. Journal of Clinical Nursing 9, 507-515 https://doi.org/10.1046/j.1365-2702.2000.00411.x.
| Google Scholar |

Doyle, P. J., McNeil, M. R., Bost, J. E., Ross, K. B., Wambaugh, J. L., Hula, W. D., Mikolic, J. M. (2007) The Burden of Stroke Scale (BOSS) provided valid, reliable, and responsive score estimates of functioning and well being during the first year of recovery from stroke. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation 16(8), 1389-1398 https://doi.org/10.1007/s11136-007-9247-8.
| Google Scholar |

Duncan, P. W., Bode, R. K., Lai, S. M., Perera, S. (2003) Rasch analysis of a new stroke-specific outcome scale: The Stroke Impact Scale. Archives of Physical Medicine and Rehabilitation 84(7), 950-963 https://doi.org/10.1016/s0003-9993(03)00035-2.
| Google Scholar |

Duncan, P. W., Lai, S. M., Tyler, D., Perera, S., Reker, D. M., Studenski, S. (2002) Evaluation of proxy responses to the Stroke Impact Scale. Stroke 33(11), 2593-2599 https://doi.org/10.1161/01.STR.0000034395.06874.3E.
| Google Scholar |

Ellis-Hill, C. S., Horn, S. (2000) Change in identity and self-concept: A new theoretical approach to recovery following a stroke. Clinical Rehabilitation 14(3), 279-287 https://doi.org/10.1191/026921500671231410.
| Google Scholar |

Engel-Yeger, B., Tse, T., Josman, N., Baum, C., Carey, L. M. (2018) Scoping review: The trajectory of recovery of participation outcomes following stroke. Behavioural Neurology 2018, 1-22 https://doi.org/10.1155/2018/5472018.
| Google Scholar |

Eriksson, G., Baum, M. C., Wolf, T. J., Tabor Connor, L. (2013) Perceived participation after stroke: The influence of activity retention, reintegration, and perceived recovery. American Journal of Occupational Therapy 67, E131-E138 https://doi.org/10.5014/ajot.2013.008292.
| Google Scholar |

Ezekiel, L., Collett, J., Mayo, N. E., Pang, L., Field, L., Dawes, H. (2019) Factors associated with participation in life situations for adults with stroke: A systematic review. Archives of Physical Medicine and Rehabilitation 100, 945-955 https://doi.org/10.1016/j.apmr.2018.06.017.
| Google Scholar |

Fallahpour, M., Jonsson, H., Jognataei, M. T., Nasrabadi Alireza, N., Tham, K. (2013) “I am not living my life”: Lived experience of participation in everyday occupations after stroke in Tehran. Journal of Rehabilitation Medicine 45, 528-534 https://doi.org/10.2340/16501977-1143.
| Google Scholar |

Geyh, S., Peter, C., Muller, R., Bickenbach, J. E., Kostanjsek, N., Ustun, B. T., Cieza, A. (2011) The personal factors of the international classification of functioning, disability and health in the literature – A systematic review and content analysis. Disability and Rehabilitation 33(13–14), 1089-1102 https://doi.org/10.3109/09638288.2010.523104.
| Google Scholar |

Goldstein, K. (1952) Effect of brain damage on personality. Psychiatry 15, 245-260.
| Google Scholar |

Gracey, F., Evans, J. J., Malley, D. (2009) Capturing process and outcome in complex rehabilitation interventions: A “Y-shaped” model. Neuropsychological Rehabilitation 19(6), 867-890 https://doi.org/10.1080/09602010903027763.
| Google Scholar |

Griffin, D., Bartholomew, K. (1994) Models of the self and other: Fundamental dimensions underlying measure of adult attachment. Journal of Personality and Social Psychology 67(3), 430-445 https://doi.org/10.1037/0022-3514.67.3.430.
| Google Scholar |

Grotkamp, S. L., Cibis, W. M., Nüchtern, E. A. M., von Mittelstaedt, G., Seger, W. K. F. (2012) Personal factors in the international classification of functioning, disability and health: Prospective evidence. The Australian Journal of Rehabilitation Counselling 18(1), 1-24 https://doi.org/10.1017/jrc.2012.4.
| Google Scholar |

Hartman-Maeir, A., Soroker, N., Ring, H., Avni, N., Katz, N. (2007) Activities, participation and satisfaction one-year post stroke. Disability and Rehabilitation 29(7), 559-566 https://doi.org/10.1080/09638280600924996.
| Google Scholar |

Herzberg, D. S., Hammen, C., Burge, D., Daley, S. E., Davila, J., Lindberg, N. (1999) Attachment cognitions predict perceived and enacted social support during late adolescence. Journal of Adolescent Research 14(4), 387-404 https://doi.org/10.1177/0743558499144001.
| Google Scholar |

Hirsh, A. T., Braden, A. L., Craggs, J. G., Jensen, M. P. (2011) Psychometric properties of the Community Integration Questionnaire is a heterogeneous sample of adults with physical disability. Archives of Physical Medicine and Rehabilitation 92(10), 1602-1610 https://doi.org/10.1016/j.apmr.2011.05.004.
| Google Scholar |

Howe, T. J. (2008) The ICF contextual factors related to speech-language pathology. International Journal of Speech-Language Pathology 19(1–2), 27-37 https://doi.org/10.1080/14417040701774824.
| Google Scholar |

Hoyle, M. F., Gustafsson, L. A., Meredith, P. J., Ownsworth, T. (2012) Participation after stroke: Do we understand all the components and relationships as categorised in the ICF? Brain Impairment 13(1), 4-15 https://doi.org/10.1017/BrImp.2012.9.
| Google Scholar |

Hunter, J. J., Maunder, R. G. (2001) Using attachment theory to understand illness behavior. General Hospital Psychiatry 23, 177-182 https://doi.org/10.1016/s0163-8343(01)00141-4.
| Google Scholar |

Kuipers, P., Kendall, M., Fleming, J., Tate, R. (2004) Comparison of the Sydney Psychosocial Reintegration Scale (SPRS) with the Community Integration Questionnaire (CIQ): Psychometric properties. Brain Injury 18(2), 161-177 https://doi.org/10.1080/0269905031000149524.
| Google Scholar |

Kwon, S., Duncan, P. W., Studenski, S., Perera, S., Lai, S. M., Reker, D. (2006) Measuring stroke impact with SIS: Construct validity of SIS telephone administration. Quality of Life Research 15(3), 367-376 https://doi.org/10.1007/s11136-005-2292-2.
| Google Scholar |

Lakshminarayan, K., Berger, A. K., Fuller, C. C., Jacobs, D. R., Anderson, D. C., Steffen, L. M., Luepker, R. V. (2014) Trends in 10-year survival of patients with stroke hospitalized between 1980 and 2000. Stroke 45, 2575-2581 https://doi.org/10.1161/STROKEAHA.114.005512.
| Google Scholar |

Lapadatu, I., Morris, R. (2019) The relationship between stroke survivors’ perceived identity and mood, self-esteem and quality of life. Neuropsychological Rehabilitation 29(2), 199-213 https://doi.org/10.1080/09602011.2016.1272468.
| Google Scholar |

Lin, K. C., Fu, T., Wu, C. Y., Hsieh, Y. W., Chen, C. L., Lee, P. C. (2010) Psychometric comparisons of the stroke impact scale 3.0 and stroke-specific quality of life scale. Quality of Life Research 19(3), 435-443 https://doi.org/10.1007/s11136-010-9597-5.
| Google Scholar |

Maunder, R. G., Hunter, J. J. (2001) Attachment and psychosomatic medicine: Developmental contributions to stress and disease. Psychosomatic Medicine 63, 556-567 https://doi.org/10.1097/00006842-200107000-00006.
| Google Scholar |

Meredith, P., Ownsworth, T., Strong, J. (2008) A review of the evidence linking adult attachment theory and chronic pain: Presenting a conceptual model. Clinical Psychology Review 28(3), 407-429 https://doi.org/10.1016/j.cpr.2007.07.009.
| Google Scholar |

Meredith, P. J., Strong, J., Feeney, J. A. (2005) Evidence of a relationship between adult attachment variables and appraisals of chronic pain. Pain Research and Management 10(4), 191-200 https://doi.org/10.1155/2005/745650.
| Google Scholar |

Mikulincer, M. (1995) Attachment style and the mental representation of the self. Journal of Personality and Social Psychology 69(6), 1203-1215 https://doi.org/10.1037/0022-3514.69.6.1203.
| Google Scholar |

Norlander, A., Iwarsson, S., Jönsson, A.-C., Lindgren, A., Måsson Lexell, E. (2018) Living and ageing with stroke: An exploration of conditions influencing participation in social and leisure activities over 15 years. Brain Injury 32(7), 858-866 https://doi.org/10.1080/02699052.2018.1463561.
| Google Scholar |

Ownsworth, T. (2014). Self-identify after brain injury - Neuropsychological rehabilitation: A modular handbook. London, UK: Psychology Press and Taylor & Francis Group.

Palstam, A., Sjödin, A., Stibrant Sunnerhagen, K. (2019) Participation and autonomy five years after stroke: A longitudinal observational study. PloS One 14(7), 1-13 https://doi.org/10.1371/journal.pone.0219513.
| Google Scholar |

Peacock, E. J., Wong, P. T. P. (1990) The Stress Appraisal Measure (SAM): A multidimensional approach to cognitive appraisal. Stress Medicine 6, 227-236 https://doi.org/10.1002/smi.2460060308.
| Google Scholar |

Pohjasvaara, T., Vataja, R., Leppävuori, A., Kaste, M., Erkinjuntti, T. (2001) Depression is an independent predictor of poor long-term functional outcome post-stroke. European Journal of Neurology 8(4), 315-319 https://doi.org/10.1046/j.1468-1331.2001.00182.x.
| Google Scholar |

Ramanathan, D. M., Wardecker, B. M., Slocomb, J. E., Hillary, F. G. (2011) Dispositional optimism and outcome following traumatic brain injury. Brain Injury 25(4), 328-337 https://doi.org/10.3109/02699052.2011.554336.
| Google Scholar |

Reddy, A., Ownsworth, T., King, J., Shields, C. (2015) A biopsychosocial investigation of changes in self-concept on the Head Injury Semantic Differential Scale. Neuropsychological Rehabilitation 27(8), 1103-1123 https://doi.org/10.1080/09602011.2015.1114499.
| Google Scholar |

Riley, G. A., Brennan, A. J., Powell, T. (2004) Threat appraisal and avoidance after traumatic brain injury: Why and how often are activities avoided? Brain Injury 18(9), 871-888 https://doi.org/10.1080/02699050410001671829.
| Google Scholar |

Rochette, A., Bravo, G., Desrosiers, J., St-Cyr Tribble, D., Bourget, A. (2007) Adaptation process, participation and depression over six months in first-stroke individuals and spouses. Clinical Rehabilitation 21(6), 554-562 https://doi.org/10.1177/0269215507073490.
| Google Scholar |

Rochette, A., Desrosiers, J., Bravo, G., St-Cyr-Tribble, D., Bourget, A. (2007) Changes in participation after a mild stroke: Quantitative and qualitative perspectives. Topics in Stroke Rehabilitation 14(3), 59-68 https://doi.org/10.1310/tsr1403-59.
| Google Scholar |

Salter, K., Foley, N., Jutai, J., Bayley, Teasell, R. (2008) Assessment of community integration following traumatic brain injury. Brain Injury 22(11), 820-835 https://doi.org/10.1080/02699050802425428.
| Google Scholar |

Scharfe, E., Bartholomew, K. (1994) Reliability and stability of adult attachment patterns. Personal Relationships 1(1), 23-43 https://doi.org/10.1111/j.1475-6811.1994.tb00053.x.
| Google Scholar |

Scheier, M. F., Carver, C. S. (1985) Optimism, coping and health: Assessment and implications of generalized outcome expectancies. Health Psychology 4(3), 219-247 https://doi.org/10.1037//0278-6133.4.3.219.
| Google Scholar |

Scheier, M. F., Carver, C. S., Bridges, M. W. (1994) Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self esteem): A reevaluation of the life orientation test. Journal of Personality and Social Psychology 67(6), 1063-1078 https://doi.org/10.1037/0022-3514.67.6.1063.
| Google Scholar |

Schmid, A. A., Damush, T., Tu, W., Bakas, T., Kroenke, K., Hendrie, H. C., Williams, L. S. (2012) Depression improvement is related to social role functioning after stroke. Archives of Physical Medicine and Rehabilitation 93(6), 978-982 https://doi.org/10.1016/j.apmr.2011.12.012.
| Google Scholar |

Schmidt, S., Nachtigall, C., Wuethrich-Martone, O., Strauss, B. (2002) Attachment and coping with chronic disease. Journal of Psychomatic Research 53, 763-773 https://doi.org/10.1016/S0022-3999(02)00335-5.
| Google Scholar |

Shifren, K., Anzaldi, K. (2018) Optimism, well-being, depressive symptoms, and perceived physical health: A study among stroke survivors. Psychology, Health & Medicine 23(1), 46-57 https://doi.org/10.1080/13548506.2017.1325505.
| Google Scholar |

Strauss, B., & Brenk-Franz, K. (2016). The relevance of attachment theory in medical care. In J. Hunter & R. Maunder (Eds.), Improving patient treatment with attachment theory: A guide for primary care practitioners and specialists (pp. 39–52): Springer International Publishing. https://doi.org/10.1007/978-3-319-23300-0_4

Tse, T., Douglas, J., Lentin, P., Carey, L. (2013) Measuring participation after stroke: A review of frequently used tools. Archives of Physical Medicine and Rehabilitation 94(1), 177-192 https://doi.org/10.1016/j.apmr.2012.09.002.
| Google Scholar |

Tse, T., Lentin, P., Douglas, J., Carey, L. M. (2020) Understanding activity participation 3-months after stroke: A mixed methodology study. Disability and Rehabilitation 22, 1-11 https://doi.org/10.1080/09638288.2020.1849429.
| Google Scholar |

Turner-Cobb, J. M., Gore-Felton, C., Marouf, F., Koopman, C., Kim, P., Israelski, D., Spiegel, D. (2002) Coping, social support, and attachment style as psychosocial correlates of adjustment in men and women with HIV/AIDS. Journal of Behavioral Medicine 25(4), 337-353 https://doi.org/10.1023/a:1015814431481.
| Google Scholar |

Tyerman, A. (1997). Head Injury Semantic Differential III. Aylesbury, Buckinghamshire, UK: Community Head Injury Service.

Tyerman, A. (2008). Facilitating psychological adjustment. In A. Tyerman & N. S. King (Eds.), Psychological approaches to rehabilitation after traumatic brain injury (pp. 320–348): Blackwell Publishing Ltd. https://doi.org/10.1002/9781444301762.ch13

Whiteneck, G. G. (2006). Conceptual models of disability: Past, present, and future. In M. Field, A. Jette, & L. Martin (Eds.), Workshop on disability in America: A new look summary and background papers (pp. 50–66). Washington, DC: Academies Press.

Whiteneck, G. G. (2010) Issues affecting the selection of participation measurement in outcomes research and clinical trials. Archives of Physical Medicine and Rehabilitation 91(9), S54-S59 https://doi.org/10.1016/j.apmr.2009.08.154.
| Google Scholar |

Willer, B., Ottenbacher, K. J., Coad, M. L. (1994) The Community Integration Questionnaire: A comparative examination. American Journal of Physical Medicine and Rehabilitation 73, 103-111 https://doi.org/10.1097/00002060-199404000-00006.
| Google Scholar |

Willer, B., Rosenthal, M., Kreutzer, J. S., Gordon, W. A., Rempel, R. (1993) Assessment of community integration following rehabilitation for traumatic brain injury. Journal of Head Trauma Rehabilitation 8(2), 75-87 https://doi.org/10.1097/00001199-199308020-00009.
| Google Scholar |

Wolf, T., Koster, J. (2013) Perceived recovery as a predictor of physical activity participation after mild stroke. Disability and Rehabilitation 35(14), 1143-1149 https://doi.org/10.3109/09638288.2012.720635.
| Google Scholar |

World Health Organization. (2001). ICF: International classification of functioning, disability and health. Geneva, Switzerland: World Health Organization.