Self-Report and Caregiver Proxy-Report Agreement of Perceived Chronic Stress and Mutuality in Poststroke Aphasia

Abstract

Background People with aphasia (PWA) report higher levels of stress in comparison to stroke survivors without aphasia. If untreated, chronic stress is known to have detrimental effects to the body and brain and can negatively impact health and well-being. According to extant literature, self- and proxy-report agreement on objective domains is higher than on subjective domains, like chronic stress. In addition, high levels of mutuality, also known as shared feelings between two people, have been strongly associated with low levels of stress in stroke survivors. Little is known, however, of the agreement between self-report and caregiver proxy-report on perceived chronic stress or mutuality in PWA. Purpose The proposed study sought to examine (a) the degree of agreement between caregiver proxy-report and PWA self-report on perceived stress and (b) the relationship between perceived stress and mutuality between PWA and their caregivers. Method The Modified Perceived Stress Scale and the Mutuality Scale were administered to 21 PWA/caregiver dyads. An independent-samples t test was conducted to determine if there were significant differences in perceived stress and mutuality as reported by PWA, their caregiver, and their caregiver's proxy-report. A Pearson correlation was performed to determine the level of agreement across questionnaires. Results There was a moderate correlation between the proxy-report and self-report for perceived stress. On average, proxy-reports for perceived stress were significantly higher than PWA self-reports. Overall, mutuality was high among the dyads. There was moderate agreement between caregiver's mutuality and proxy-report agreement on perceived stress. Lastly, our findings do not indicate that caregiver's perceived stress influenced their perception of the PWA's perceived stress. Conclusion The results of this study provide support for the use of proxy-derived information in perceived stress with the use of a mutuality scale.

An Integrative Review of the Utilization of the Perceived Stress Scale in Stroke Recovery

“…The most frequently used version of the scale was the PSS-10, found in 7 studies 2,19–24 . The PSS-14 was used less often, followed by the PSS-4 and the modified PSS 3,25–29 . Many studies (9) reported on the type and location of stroke (ie, descriptors including ischemic, hemorrhagic, left hemispheric, or right hemispheric stroke).…”

“…The PSS was collected at multiple time points across studies. In cross-sectional studies, collection varied from time of hospital admission to 7 days after stroke, a few months, or even 12 months or greater post stroke 2,3,19,20,25–28 . These studies reported moderate to high levels of PS, ranging from 5.0 for the PSS-4, 14.04 to 16.90 for the PSS-10, and 29.62 for the PSS-14 2,3,19,20,26,28 .…”

“…Although there are many additional contributing factors, most works found a correlation between scores in stroke severity and PS. 2,3,19,20,25,26 Worsening neurological deficits (National Institutes of Health Stroke Scale), poor scores on the Stroke Impact Scale, and greater impairment of cognitive function (cognitive FIM) and motor function (motor FIM) were associated with higher levels of PS. 2,3,19,20,25,26 PSS in Cross-sectional Studies.…”

“…Stroke is a leading cause of long-term disability, and almost 75% of survivors are left with some degree of physical disability 1 . Consequently, these patients may have to relearn how to perform activities of daily living while simultaneously trying to regain control of emotional and cognitive functions 2,3 . The reality of navigating this “new normal” contributes to a high level of stress that is felt by many stroke survivors (SS) 4,5 …”

“…1 Consequently, these patients may have to relearn how to perform activities of daily living while simultaneously trying to regain control of emotional and cognitive functions. 2,3 The reality of navigating this "new normal" contributes to a high level of stress that is felt by many stroke survivors (SS). 4,5 Stress disrupts the balance in a person's life and can be classified into 3 main categories: environmental, psychological, and biological.…”