Association between pre-stroke social participation and current physical resilience across frailty levels among middle-aged and older stroke survivors: A cross-sectional study

Background Physical resilience and frailty are related but distinct constructs that may shape adaptation after stroke. Evidence concerning whether pre-stroke social participation is associated with physical resilience across different frailty levels remains limited. Methods This single-center cross-sectional study included 314 adults aged 45 years or older with imaging-confirmed stroke. Participants retrospectively reported seven types of social participation during the six months before stroke. Current frailty and physical resilience were assessed at enrollment using the FRAIL scale and the Physical Resilience Instrument for Older Adults. Participants were classified as non-frail, pre-frail, or frail. Multivariable linear regression with HC3 robust standard errors evaluated the association between social participation and physical resilience. Interaction terms tested whether the association differed by frailty category. Results Of 314 participants, 140 (44.6%) were non-frail, 149 (47.5%) were pre-frail, and 25 (8.0%) were frail. Social participation and physical resilience showed a weak positive correlation in the full sample (r = 0.295, 95% CI 0.190 to 0.392; p < 0.001). After adjustment for age, sex, monthly income, hypertension, diabetes, and frailty category, each one-point higher social participation score was associated with a 0.725-point higher physical resilience score (95% CI 0.405 to 1.044; p < 0.001). The social participation-by-frailty interaction was not statistically significant (joint p = 0.314). Results were consistent in analyses restricted to participants aged 60 years or older and 65 years or older. Conclusions Retrospectively reported pre-stroke social participation was weakly and positively associated with current physical resilience across frailty levels. The cross-sectional design, retrospective exposure assessment, and limited size of the frail subgroup preclude causal or intervention conclusions.