Time-Varying Risk Factors Associated With the Progress of Functional Recovery and Psychological Distress in First-Ever Stroke Patients

Abstract

BACKGROUND: Evaluation of stroke recovery outcome is crucial and a major goal of clinical practice. A recovery trajectory model serves as a prognostic tool that enables development of effective intervention and long-term management to improve poststroke recovery outcomes. This study explored time-varying risk factors associated with the progression of functional recovery and psychological distress poststroke. METHODS: Participants were patients with first-ever stroke who underwent assessment for activities of daily living, psychological distress, and social support at the onset (within 72 hours) and at 1, 3, and 6 months. A generalized estimation equation was used to account for the correlation between the repeated measurements. RESULTS: Of the 101 patients, 60.4% were men, and the mean (SD) age was 63.06 (13.12) years. Over time, the physical functions of patients after stroke significantly increased, and anxiety and depression significantly decreased. Approximately 50% of patients achieved full functional recovery after 6 months. The time-varying risk factors for National Institutes of Health Stroke Scale scores and depression levels affected the trajectory of functional recovery during follow-up. Factors associated with patient anxiety levels were National Institutes of Health Stroke Scale scores and depression levels. Factors associated with patient depression levels included education, anxiety, and social support levels. CONCLUSION: This study demonstrates the progression of time-varying risk factors for functional recovery and psychological distress in patients with first-ever stroke. We recommend that nurses work with patients and their families in the early poststroke stages to identify comprehensive goals based on individual needs and related factors at different stages and that they educate patients on what is required for them to regain independence.

Cerebrovascular risk factors and their time-dependent effects on stroke survival in the EMMA cohort study

“…Also, depression was associated with anxiety, low social support levels, and low education. The main conclusions of this study revealed the importance of early poststroke rehabilitation with 50% of patients with full functional recovery after 6 months, but the effect of time-varying risk factors on mortality was not included in the analyses of Liu et al (22). In our study, although we evaluated mostly variables measured at baseline, we also found that functional disability should be addressed as early as possible due to its stronger association with mortality in the first 2 years.…”

“…Their findings make evident the importance of accounting for the time-dependent effects of baseline variables, especially as the cohort ages during follow-up years. Other previous studies with stroke populations used different methodology to evaluate the time-varying risk of some selected risk factors (21,22). In the study of Huang et al (21), the time-varying effects of psychological distress on the functional recovery of stroke patients were analyzed.…”

“…In the study of Liu et al (22), risk factors associated with functional recovery and psychological distress in stroke patients were evaluated using 3 different measurements in time, and it was demonstrated that the National Institutes of Health Stroke Scale scores (NIHSS) and depression levels affected functional recovery. Also, depression was associated with anxiety, low social support levels, and low education.…”