The influence of psychological factors and mood on the course of participation up to four years after stroke

Figures & data

Table 1. Participant characteristics.

Study participants:		Total (n = 369)	At 4 years (n = 136)	Dropouts (n = 233)	p Values^b
Demographic factors
Sex (% male)		64.5	68.4	62.2	0.415
Age in years		66.7 ± 12.4	64.0 ± 10.9	68.3 ± 12.9	0.020*
Marital status (% living together)		69.4	74.3	66.5	0.284
High education level (%)^a		27.0	27.2	26.8	0.959
Stroke-related factors
Ischemic stroke (%)		93.0	91.9	93.6	0.690
Left hemisphere (%)		40.2	34.8	43.3	0.257
First stroke (%)		87.5	85.3	88.8	0.168
Severity of stroke four days after stroke (NIHSS)		2.7 ± 3.2	2.7 ± 3.0	2.7 ± 3.3	0.738
No stroke symptoms (% NIHSS 0)		24.4	23.5	24.9
Minor stroke symptoms (% NIHSS 1-4)		56.1	56.6	55.8
Moderate stroke symptoms (% NIHSS 5-12)		17.3	18.4	16.7
Severe stroke symptoms (% NIHSS ≥ 13)		2.2	1.5	2.6
ADL 2 months after stroke (BI)		20 ± 2.1	20 ± 1.3	20 ± 2.4	0.022*
% ADL-dependent (BI ≤17)		9.4	4.6	12.2	0.019*
Cognitive functioning 2 months after stroke (MoCA)		23.6 ± 4.0	24.3 ± 3.6	23.1 ± 4.2	0.119
% cognitively impaired (MoCA ≤ 25)		67.6	60.0	72.2	0.076
Length of stay in hospital (in days)		8.5 ± 6.2	8.0 ± 5.5	8.8 ± 6.6	0.289
Discharge home after hospital stay (%)		71.0	75.0	68.7	0.374
Mood
Mood 2 months after stroke (HADS)		9.4 ± 7.3	9.7 ± 6.5	9.2 ± 7.7	0.366
% impaired (HADS ≥11)		37.4	44.3	33.2	0.170
Psychological functioning
Extraversion (EPQ-RSS-E)	n = 345	7.1 ± 3.2	7.1 ± 3.4	7.1 ± 3.1	0.989
Neuroticism (EPQ-RSS-N)	n = 345	3.6 ± 3.1	3.6 ± 3.3	3.7 ± 3.0	0.679
Optimism (LOT-R)	n = 346	8.2 ± 2.1	8.1 ± 2.0	8.2 ± 2.2	0.788
Pessimism (LOT-R)	n = 345	4.4 ± 2.8	4.2 ± 2.6	4.5 ± 2.9	0.521
Self-efficacy (GSES)	n = 345	31.6 ± 6.4	32.0 ± 5.6	31.3 ± 6.8	0.782
Proactive coping (UPCC)	n = 345	64.8 ± 11.9	66.1 ± 10.7	64.0 ± 12.5	0.385
Passive coping (UCL-P)	n = 346	10.5 ± 2.8	10.7 ± 2.6	10.4 ± 3.0	0.266

Values are percentages or mean ± SD. ADL: activities of daily living; BI: Barthel Index; EPQ-RSS-N and EPQ-RSS-E: Eysenck Personality Questionnaire Revised Short Scale Neuroticism and Extraversion; GSES: General Self-Efficacy Scale; LOT-R: Life Orientation Test-Revised; UCL-P: Utrecht Coping List; UPCC: Utrecht Proactive Coping Competence List.

^aCompleted University of Professional Education and higher.

^bComparison between population ’at four years’ and ‘dropouts’.

*p values are significant (p < 0.05).

Figure 1. The course of the proportion of participants (who completed the follow up till four years after stroke, n = 136) experiencing restrictions in participation items over time.

Table 2. Course of participation after stroke of participants who completed the follow up till four years after stroke (n = 136).

USER-P restriction scale^a	2 months^c	6 months^c	1 year^c	2 years^c	4 years^c	p Value^c
Mean (SD)	74.1 (±21.3)	80.9 (±18.3)^#	82.9 (±19.0)^#	82.1 (±21.2)	83.0 (±20.1)	<0.001*
Median	75.8	85.7	87.5	91.3	91.8
IQR	57.6–93.9	69.7–96.7	70.8–100	66.8–100	70.9–100
Restriction scale items:	Persisting restrictions in items USER-P (%)^b
Work/education	78.3	66.7	47.3^#	46.6	35.7	<0.001*
Housekeeping	60.8	52.0	48.4	44.8	42.5	0.002*
Mobility	59.5	44.9^#	34.4^#	34.1	30.0	<0.001*
Physical exercise	62.2	54.2	53.2	46.7	51.6	0.020*
Going out	59.6	47.1^#	36.0	41.8	38.3	<0.001*
Outdoor activities	60.2	48.6^#	46.0	48.3	44.6	0.002*
Leisure indoors	39.0	27.5^#	24.8	20.8	20.5	<0.001*
Partner relationship	22.6	31.3	33.3	31.5	32.2	0.397
Visits to family/friends	49.6	40.3	29.5	33.3	30.5	<0.001*
Visits from family/friends	24.4	27.3	18.9	21.1	17.8	0.118
Telephone/PC contact	16.7	19.4	21.5	16.9	20.3	0.723

IQR: interquartile range.

^aUSER-P restriction scale: higher score indicates good level of participation (less restrictions).

^bUSER-P restriction items values are percentages of participants who are restricted.

^cDifferent p values were calculated to ascertain significant differences between all time points (cited with *) and between two consecutive time points (cited with^#).

^#p values are significant (p < 0.05), comparing the cited time point with the previous time point.

*p values are significant (p < 0.05), comparing all time points.

Table 3. Linear mixed model analyses showing the predictions of participation restrictions (USER-P restrictions subscale) over time.

	Model 1: basic model		Model 2a: HADS		Model 2b: M-PF		Model 2c: A-PF		Model 3: final model
	Coef. β	95% CI	Coef. β	95% CI	Coef. β	95% CI	Coef. β	95% CI	Coef. β	95% CI
Intercept	63.03**	45.56–80.50	84.60**	68.09–101.11	100.51**	80.50–120.53	35.79**	17.96–53.61	66.44**	43.67–89.21
Time	0.44**	0.28–0.60	0.45**	0.29–0.61	0.43**	0.27–0.59	0.44**	0.28–0.60	0.44**	0.28–0.61
Time*Time	−0.01**	−.01–0	−0.01**	−0.01–0	−0.01**	−0.01–0	−0.01**	−0.01–0	−0.01**	−0.01–0
Age	−0.13	−0.28–0.02	−0.21*	−0.34–−0.07	−0.16*	−0.30–−0.02	−0.12	−0.26–0.02	−0.18*	−0.32–−0.05
Gender	6.80**	3.23–10.37	5.25**	2.08–8.43	5.15*	1.73–8.57	6.00**	2.63–9.36	5.08*	1.94–8.22
Education	0.40	−3.21–4.02	−0.13	−3.31–3.05	1.04	−2.38- 4.47	1.49	−1.91-4.88	0.53	−2.62–3.69
Stroke severity (NIHSS)	−1.12**	−1.77–−0.47	−1.34**	−1.91–−0.77	−0.99*	−1.61–−0.38	−0.96*	−1.57–−0.34	−1.18**	−1.75–−0.61
Cognitive functioning (MoCA)	0.89**	0.41–1.36	0.67*	0.24–1.09	0.58*	0.12–1.03	0.77**	0.32–1.21	0.68*	0.26–1.11
Discharge destination	−9.58**	−13.97–−5.20	−8.05**	−11.93–−4.17	−10.27**	−14.42–−6.12	−10.32**	−14.46–−6.17	−9.15**	−13.02–−5.29
Emotional functioning (HADS)			−1.08**	−1.29–−0.86					−0.95**	−1.24–−0.66
Maladaptive psychological scale					−0.56**	−0.72–−0.39			0.02	−0.19-0.24
Adaptive psychological scale							0.58**	0.42-0.75	0.27*	0.09-0.44
−2 Restricted Log Likelihood Ratio	11720.76		11513.00		11575.97		11567.72		11380.49

β: standardized regression coefficient; CI: confidence interval.

*p < 0.05.

**p < 0.001.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.