Social Support Mediates the Association Between Abilities and Participation After Stroke.

Stroke survivors face participation restrictions, yet little is known regarding how social support affects the association between an individual's abilities and participation. Through a Person-Environment-Occupation-Performance (PEOP) model lens, social support was examined as a potential mediator between ability and participation in cognitively and mobility-demanding activities for stroke survivors with aphasia (persons with aphasia [PWA]) and without aphasia (persons without aphasia [PWOA]). A cross-sectional design, including PWA (n = 50) and PWOA (n = 59) examined associations among person factors (physical impairment, cognition), an environmental factor (social support), and occupational participation through cognitively- and mobility-demanding activity subscales of the Activity Card Sort. Cognition was associated with participation in cognitively demanding activities for both groups, though social support was a mediator only for PWA. Physical impairment was associated with participation in mobility-demanding activities for PWOA, though social support did not mediate that relationship. Social support is key to PWA participating in cognitively demanding activities post-stroke.

Social Support's Role in Tasks that Require Cognition or Mobility for Stroke Survivors with and without AphasiaAfter a stroke, people can face difficulties doing the things they need and want to do in their daily life. Sometimes a stroke can cause aphasia, a disorder that can make it hard for someone to communicate. Social support occurs when one person helps someone do the things they need and want to do. Certain tasks may require different skills, like cognition (being able to think) or mobility (being able to move). Results showed that cognition is important to do tasks that require a lot of thinking for people who experience a stroke and social support is essential for people with aphasia to do tasks that require a lot of thinking. In addition, mobility is important to do tasks that require walking or movement for people without aphasia.

Person and Environment Factors Supporting Self-Care Performance and Social Participation After Mild Stroke.

Mild stroke survivors seldom receive occupational therapy services as their deficits are assumed to be minor enough to not affect their daily occupations. Yet many mild stroke survivors report deficits in self-care performance and social participation. This study investigates person and environment factors influencing self-care performance and social participation among mild stroke survivors, using the Person-Environment-Occupation-Performance (PEOP) model. A retrospective cohort analysis of 736 mild stroke survivors was conducted using electronic health records. Person factors included demographic characteristics and clinical characteristics, and environment factors included the Social Vulnerability Index. The analysis included logistic regression. Approximately, 10% of patients reported deficits in self-care or social participation. Disability level was the only person factor associated with self-care performance. Person factors affecting social participation included mobility and unemployment. Socioeconomic status was associated with both occupation measures. Occupational therapy practitioners must address the person and environment factors affecting mild stroke survivors' self-care performance and social participation.

Person and Environment Factors Supporting Mild Stroke Survivors' Ability to Take Care of Themselves and Their Social LivesThis study looked at what happens to people after they have had a mild stroke. We wanted to find out what makes some people independent in taking care of themselves and able to socialize after a mild stroke, whereas others have more difficulty. To do this, we looked at many factors that were measured in the patients' hospital record, such as age, type of stroke, and where they live. We used their address to determine information about their neighborhood and how that may affect their independence and social lives. We found that patients who were less disabled had an easier time taking care of themselves. We found that patients who had difficulty moving or were unemployed had difficulty with their social lives. A patient's social life was also associated with whether they got therapy. Patients who lived in low-income neighborhoods had difficulties with taking care of themselves and with their social lives. Occupational therapists must understand the importance of addressing these factors when supporting patients with a mild stroke with their ability to take care of themselves and engage in their social lives.

Experiences With Mobile Health-Enabled Ambulatory Monitoring Among Stroke Survivors: A Qualitative Study.

Inquiring into the experiences of stroke survivors toward ambulatory monitoring is crucial for optimizing user adoption, design, implementation, and sustainability of ambulatory monitoring in the stroke population. This study was aimed to identify facilitators and barriers for ambulatory monitoring among stroke survivors, as well as their suggestions for development and implementation of ambulatory monitoring. We conducted individual semi-structured interviews with 40 stroke survivors who received ambulatory monitoring. The interviews were analyzed using thematic content analysis. Six themes about facilitators associated with ambulatory monitoring emerged: (1) user support, (2) technological features, (3) convenience, (4) personal strategies, (5)social influence, and (6)time commitment. Three themes about barriers to using ambulatory monitoring emerged: (1) personal factors, (2) functionality, (3) study design. Three themes about suggestions emerged: (1) personalization, (2) functionality, and (3) interactive feedback. As mobile health technology is becoming more popular, the findings of this study provide timely implications and practical considerations for ambulatory monitoring in the stroke population.

Understanding the experiences of individuals with stroke toward ambulatory monitoringAmbulatory monitoring overcomes many limitations of traditional paper­pencil assessment and laboratory-based testing, emerging as a promising tool to assess daily functioning. However, there has been low adoption of ambulatory monitoring by people with chronic conditions. In this study, the researchers interviewed 40 individuals with stroke about their experiences, including facilitators, barriers, and suggestions associated with ambulatory monitoring. The findings identified six types of facilitators that should be included in the design of future ambulatory monitoring to enhance pleasant user experiences, three types of barriers that should be excluded to improve adherence, and three types of suggestions that should be considered to meet the needs of individuals with stroke. These important findings will be timely to inform the development of ambulatory monitoring for the stroke population.

Racial disparities among mild stroke survivors: predictors of home discharge from a retrospective analysis.

BACKGROUND: Half of all strokes are classified as mild, and most mild stroke survivors are discharged home after their initial hospitalization without any post-acute rehabilitation despite experiencing cognitive, psychosocial, motor, and mobility impairments. OBJECTIVES: To investigate the demographic and clinical characteristics of mild stroke survivors and their association with discharge location. METHODS: This is a retrospective analysis of mild stroke survivors from 2015-2023 in an academic medical center. Demographic characteristics, clinical measures, and discharge locations were obtained from the electronic health record. The Social Vulnerability Index was used to measure the community vulnerability. Associations between variables and discharge location were examined using bivariate logistic regression analysis. RESULTS: There were 2,953 mild stroke survivors included in this study. The majority of participants were White (65.46%), followed by Black (19.40%). Black stroke survivors and individuals with higher social vulnerability had a higher proportion of discharges to skilled nursing facilities (p = 0.001). Black patients and patients with high vulnerability in housing type and transportation were less likely to be discharged home. CONCLUSIONS: Mild stroke survivors have a high rate of home discharge, potentially because less severe stroke symptoms have a reduced need for intensive care. Racial disparities in discharge location were evident, with Black stroke survivors experiencing higher rates of institutionalized care and lower likelihood of being discharged home compared to White counterparts, emphasizing the importance of addressing these disparities for equitable healthcare delivery and optimal outcomes.

Application of the Person-Environment-Occupation-Performance Model: A Scoping Review.

The Person-Environment-Occupation-Performance (PEOP) Model is one of several occupation-based models in occupational therapy. The model describes the transactional nature of person, environment, and occupation factors that support performance (doing), participation (engagement), and well-being (health and quality of life). The purpose of this study was to explore the extent and nature of evidence on the PEOP Model. We used a scoping review to identify and analyze journal articles that used the PEOP Model as a framework for study. The PRISMA extension for scoping reviews (PRISMA-ScR) criteria were used to develop the research methods. We found 109 articles that adopted the PEOP Model as an organizing framework. The studies reviewed represent the breadth of occupational therapy practice and the transactional nature of person, environment, occupation, and performance in the PEOP Model. The PEOP Model is a useful international framework for research and practice across populations, conditions, life circumstances, settings, and areas of practice.

METHOD: We searched five databases to identify published articles that used the PEOP Model. Then, we analyzed our findings from peer-reviewed journals and peer-reviewed practice publications using a recommended process called a scoping review. We summarized how often the PEOP Model was used and the way in which it was used. FINDINGS: We found the PEOP Model was used in more than 100 published articles. The PEOP Model has been used to study everyday living for different populations, life circumstances, countries, and communities. Authors found the PEOP Model was helpful for identifying what was important to individuals and determining things that were helpful and barriers to everyday living. CONCLUSION: Authors described the PEOP Model as a useful tool in their research methods and analyses. Occupational therapy professionals may find the PEOP Model helpful in current and innovative areas of practice to help people achieve their goals related to everyday living.

The Person­Environment­Occupation­Performance (PEOP) Model: Summary of Current Research on an Occupational Therapy Lens for Everyday LivingBackground and Purpose: The Person­Environment­Occupation­Performance (PEOP) Model was developed to guide occupational therapy practice. The PEOP Model summarizes all the factors that support or limit our involvement in everyday living. By everyday living, we mean all the things we do to take care of ourselves, maintain our health and home, connect with friends and family, engage in meaningful activities, and support ourselves and our community through work and volunteering. The purpose of this study was to summarize the reasons why and the extent to which the PEOP Model was used in research and practice.

Social participation mediates the relationship between self-efficacy and loneliness among people with stroke during COVID-19: a cross-sectional study.

BACKGROUND: People post-stroke experience increased loneliness, compared to their healthy peers and loneliness may have increased during COVID due to social distancing. How social distancing affected loneliness among people after stroke is unknown. Bandura's self-efficacy theory suggests that self-efficacy may be a critical component affecting individuals' emotions, behaviors, attitudes, and interpretation of everyday situations. Additionally, previous studies indicate that self-efficacy is associated with both loneliness and social participation. This study investigates relationships among self-efficacy, social participation, and loneliness in people with stroke. OBJECTIVES: Determine how social participation affects the relationship between self-efficacy and loneliness in people with stroke during the COVID-19 pandemic. METHODS: 44 participants were community-dwelling individuals, ≥ 6 months post-stroke who participated in a 2-hour phone interview. A regression-based mediation analysis was conducted using these measures: Participation Strategies Self-Efficacy Scale, Activity Card Sort for social participation, and UCLA Loneliness Scale for loneliness. RESULTS: The total effect of self-efficacy on loneliness was significant (b = -0.36, p = .01). However, social participation fully mediated the relationship between self-efficacy and loneliness (indirect effect, b = -0.11, 95% CI [-0.24, -0.01]; direct effect, b = -0.25, 95% CI [-0.03, 0]). CONCLUSIONS: Self-efficacy is associated with both social participation and loneliness in people with stroke in this cross-sectional study. Mediation analysis findings suggest that interventions focused on increasing social participation may prevent or potentially alleviate loneliness in people with stroke who have low self-efficacy.

Participation and Its Association With Health Among Community-Dwelling Adults With Chronic Stroke.

IMPORTANCE: Little is known about the severity of participation restrictions among people living in the community with chronic stroke. Even less is known about the association between participation and health in this population. OBJECTIVE: To describe participation among people with chronic stroke and examine the association between participation and physical and mental health. DESIGN: Secondary analysis of baseline data from an intervention study. SETTING: The parent multisite intervention study was conducted in the community, and assessments were administered in participants' homes. PARTICIPANTS: Thirty-one community-dwelling adults with chronic stroke. OUTCOMES AND MEASURES: Participation was measured with the Activity Card Sort (percentage of prestroke activities retained) and the Enfranchisement Scale of the Community Participation Indicators. Health was measured with the PROMIS®-29 Physical Health and Mental Health subscales. We calculated descriptive statistics for participation measures and Spearman's ρ correlations between participation and health outcomes. RESULTS: Participation scores were poor on all measures of participation. Most striking, 94.9% of participants retained less than 80% of their prestroke activities. All measures of participation were modestly correlated with physical health (ρ = .28-.46) and were moderately correlated with mental health (ρ = .42-.63). CONCLUSIONS AND RELEVANCE: Participation restrictions are prevalent among adults with chronic stroke, with potential implications for mental health. Stronger community-based rehabilitation and support services to enhance participation of this high-risk population are warranted. What This Article Adds: This report highlights the severity of participation restrictions among people with chronic stroke. Moreover, this report shows that people with stroke feel a lack of inclusion in the community and that participation is associated with mental and physical health.

Feasibility of Telehealth Occupational Therapy for Behavioral Symptoms of Adults With Dementia: Randomized Controlled Trial.

IMPORTANCE: Supporting community residency of adults with Alzheimer's disease (AD) is a critical public health initiative. Occupational therapy can contribute to this goal. OBJECTIVE: To assess the feasibility of a novel telehealth intervention to support occupational engagement in community-residing people with AD. DESIGN: Single-blind, three-arm, parallel, randomized controlled trial. SETTING: Occupational therapy delivered through telehealth in participants' homes. PARTICIPANTS: People with AD who reside in the community with behavioral symptoms and their care partners (dyads). INTERVENTIONS: (1) HARMONY (Helping older Adults cReate & Manage OccupatioNs successfully), a telehealth intervention that applies principles of individualized guided discovery with environmental cueing for caregivers of persons with AD to promote activity participation and manage behavioral symptoms; (2) standardized training regarding the use of a sensory-based approach in dementia care; and (3) a control, including home safety education and weekly monitoring of behaviors. OUTCOMES AND MEASURES: Feasibility was assessed as the primary outcome measured by completion of at least 75% of the telehealth sessions. Secondary outcomes included change in functional activity performance and neuropsychiatric behavioral symptoms. RESULTS: Twenty-eight dyads participated. The intervention was feasible, with high adherence to weekly visits (M number of visits = 5.4 for HARMONY, 4.9 for standardized training, and 4.6 for control), with high participant retention in the intervention arms. HARMONY demonstrated promise in improving patient performance and behavioral symptoms. CONCLUSIONS AND RELEVANCE: HARMONY is feasibly delivered through telehealth service and has a positive effect on occupational performance and behavioral symptoms of AD. Additional studies are needed to explore effectiveness in a broader population. What This Article Adds: Use of HARMONY for community-residing adults with AD is feasible and has promise for improving functional activity performance and behavioral symptoms, as well as caregiver satisfaction.

An Exploratory Study of Young Stroke Survivors' Lived Experiences: A Multi-Methods Study Using Developmental Theory.

Young adults make up 10% of strokes that occur in the United States each year. Little research has shown the developmental and occupational disruption as a result of stroke for this population. The objective of this study was to describe young stroke survivors' perceived disruptions using developmental theory. A multiple methods study was conducted with community-dwelling stroke survivors between the ages of 18 and 40 using Patient-Reported Outcomes Measurement Information System (PROMIS) measures and qualitative interviews. Five themes were reported from the qualitative data: stroke and health, work and school, romantic relationships, parenting, and other social relationships. PROMIS measure results were not significantly different from the normed population despite challenges revealed during qualitative interviews. Qualitative data showed variations in post-stroke deficits and occupational performance that could not be meaningfully captured by the PROMIS measures alone. Occupational therapy practitioners should use developmental theory to guide their understanding of occupational disruptions in young stroke survivors.

Functional Cognition: Distinct From Fluid and Crystallized Cognition?

IMPORTANCE: Functional cognition is emerging as a professional priority for occupational therapy practice. It is important to understand how it relates to other established cognitive constructs, so that occupational therapists can demonstrate their unique contributions. OBJECTIVE: To examine whether functional cognition is a construct that is distinct from crystallized and fluid cognitive abilities. DESIGN: Secondary analysis of data collected from a cross-sectional study. SETTING: Community. PARTICIPANTS: Adults with spinal cord injury, traumatic brain injury, or stroke (N = 493). OUTCOMES AND MEASURES: The National Institutes of Health Toolbox Cognition Battery and the Executive Function Performance Test. RESULTS: We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to investigate the factor structure of cognition. EFA identified three factors representing crystallized, fluid, and functional cognition. CFA revealed a second-order model in which the three cognitive constructs contribute hierarchically to a general cognitive factor. CONCLUSIONS AND RELEVANCE: This study provides important and timely evidence for establishing functional cognition as a unique construct that is distinct from executive function as well as from fluid and crystallized cognition. Functional cognition is central to performance in daily activities, and its use will ensure that occupational therapy services support continued recovery and community reintegration. What This Article Adds: This study supports occupational therapy professionals in establishing the profession's role in evaluating and treating deficits of functional cognition to support patients' return to desired occupations in the family, workplace, and community.

Rest-Activity Rhythm Characteristics Associated With Depression Symptoms in Stroke Survivors.

OBJECTIVE: To examine which 24-hour rest-activity rhythm (RAR) characteristics are associated with depression symptoms in stroke survivors. DESIGN: Cross-sectional observational study examining associations of RAR characteristics with the presence of depression symptoms adjusting for age, sex, race, and medical comorbidity. SETTING: Community setting. PARTICIPANTS: Stroke survivors: (1) recruited locally (N women=35, N men=28) and (2) a nationally representative probability sample (the National Health and Nutrition Examination Survey [NHANES]; N women=156, N men=124). INTERVENTIONS: None. MEASUREMENTS: Objective RAR characteristics derived from accelerometer recordings including activity onset/offset times and non-parametric measures of RAR strength (relative amplitude), stability (interdaily stability), and fragmentation (intradaily variability). The presence of depression symptoms was categorized using Patient Health Questionnaire scores. RESULTS: In both samples, the only RAR characteristic associated with depression symptoms was intradaily variability (fragmentation): local sample, odds ratio=1.96 [95% confidence interval=1.05-3.63]; NHANES sample, odds ratio=1.34, [95% confidence interval=1.01-1.78]). In the NHANES sample, which included both mild and moderate/severe depression, the association between 24-hour sleep-wake fragmentation and depression symptoms was driven by moderate-to-severe cases. CONCLUSIONS: Stroke survivors with higher levels of RAR fragmentation were more likely to have depression symptoms in both samples. These findings have implications, given prior studies in general samples linking RAR fragmentation with future depression and dementia risk. Research is needed to establish the potential consequences, mechanisms, and modifiability of RAR fragmentation in stroke survivors.

Motivation, Physical Activity, and Affect in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Approach.

BACKGROUND: Motivation is a frequently reported but far less studied driver for post-stroke physical activity participation. Motivation and physical activity may be important contributors to the prevention management and alleviation of affective symptoms among stroke survivors. PURPOSE: To investigate the real-time associations between motivation, physical activity, and affect in the daily lives of community-dwelling stroke survivors using ecological momentary assessment (EMA) and accelerometry. METHODS: Forty community-dwelling stroke survivors wore an accelerometer on the thigh and completed EMA surveys assessing motivation (autonomous motivation, controlled motivation) and affect (negative affect, positive affect) eight times daily for 7 days. Multivariate regression analysis and multilevel modeling investigated the associations between motivation, physical activity, and affect. RESULTS: Greater autonomous motivation for physical activity was associated with less sedentary behavior (ß = -0.40, p = .049) and more moderate-to-vigorous physical activity (ß = 0.45, p = .020) participation in daily life. Greater autonomous motivation was momentarily associated with less depressed affect (ß = -0.05, p < .001) and greater positive affect (ß = 0.13, p < .001). Moreover, greater controlled motivation was momentarily associated with greater depressed affect (ß = 0.06, p < .001). More intense physical activity was momentarily associated with greater positive affect (ß = 0.13, p = .016). No moderating effect of motivation on the association between physical activity and affect was found. CONCLUSIONS: Motivation and physical activity are momentarily associated with affect among stroke survivors. Assessing and fostering autonomous motivation may be beneficial for promoting physical activity and managing positive and depressed affect as stroke survivors return to the community.

Evaluation of an occupational therapy reentry program: Achieving goals to support employment and community living after incarceration.

BACKGROUND: Individuals released from prisons to community supervision often experience unstable housing, unemployment, substance misuse, mental ill-health, and lack of support systems contributing to high rates of recidivism. Occupational therapy practitioners have distinct value in promoting engagement in new habits and routines to support "occupation," or development of daily living skills to support community reentry. OBJECTIVE: We developed an occupational therapy (OT) program within a Department of Corrections (DOC) Community Supervision Center in the Midwest United States. The purpose of this study was to determine feasibility and efficacy of an OT program for community reentry. METHODS: The program was piloted with a sample of five justice-involved men who received OT interventions. Pre- and post-test assessments included a behavioral health interview, demographic survey, five Patient-Reported Outcomes Measurement Information System (PROMIS) assessments, the Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT) and Activity Card Sort-Advancing Inclusive Assessment. Descriptive analyses were performed to determine goal attainment and compare pre- and post-test scores over time and to a reference population (PROMIS). Staff of the DOC were also interviewed to assess perceived feasibility and efficacy of this pilot. RESULTS: Significant health changes were reported in participant self-efficacy, managing emotions, anxiety, and sleep disturbances (1 > SD). Moderate changes were seen in reduced feelings of social isolation (0.5 > 1SD). CONCLUSION: It was feasible to implement an OT program with tailored reentry interventions based on unique needs of criminal justice involved individuals. Initial findings suggest OT offers health promotion benefits to reduce risk of recidivism and prepare individuals for community reentry following incarceration.

Psychometric properties of the Center for Epidemiologic Studies Depression (CES-D) scale in stroke survivors.

PURPOSE: This study aimed to evaluate the psychometric properties of the Center for Epidemiologic Studies Depression (CES-D) scale in adults with stroke. METHODS: A secondary analysis of the Stroke Recovery in Underserved Populations Cohort Study. The CES-D was administrated to 828 stroke patients at discharge from inpatient rehabilitation facilities and at 3- and 12-month follow-ups. Data were analyzed using classical test theory (CTT) and Rasch measurement model. RESULTS: Confirmatory factor analyses of the CES-D items showed excellent fit of a four-factor model (CFI = 0.98; TLI = 0.98; RMSEA = 0.05). CTT analyses revealed satisfactory reliability and validity. Rasch analyses also supported the unidimensionality of each factor (subscale). Wright maps indicated a floor effect and item gaps. A few items displayed differential item functioning: 3 items (1 depressed affect and 2 somatic symptoms) across gender, 1 item (depressed affect) across time of assessment and all # somatic symptom items across time of assessment. CONCLUSION: The four-factor structure of the CES-D was confirmed and its psychometric properties were validated, supporting the use of four subscales to characterize depressive symptomatology in adults with stroke. Supplementary assessments are needed for evaluating and comparing somatic symptoms over time. A refinement of the CES-D was recommended to better differentiate stroke survivors with subtle depressive symptoms.

Cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury.

BACKGROUND: Community participation is an important outcome of rehabilitation following traumatic brain injury. Yet, few measures assess inclusion and belonging (enfranchisement) as a dimension of community participation. The Enfranchisement scale of the Community Participation Indicators addresses this need. However, research on its psychometric properties is lacking. OBJECTIVE: To examine cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury. DESIGN: This was a repeated measures study with assessments administered twice (3 months apart). SETTING: Assessments were administered either over the phone, virtually (Zoom), or in person at the participant's home. PARTICIPANTS: A total of 44 participants from community settings who had either experienced a traumatic brain injury within the previous year or were receiving rehabilitation interventions were recruited. MAIN OUTCOME MEASURE: The Enfranchisement scale has two subscales: the Control subscale (range: 13-65) and the Importance subscale (range: 14-70). On both subscales, lower scores indicate better enfranchisement. METHODS: The software SAS PROC Logistic and the macro %ROCPlot were used to examine cut points at varying levels of sensitivity and specificity. The area under the receiver operating characteristics curve was calculated to determine overall classification accuracy. Minimum detectable change and minimal clinically important difference were also calculated. RESULTS: For the Control subscale, a cut point of 44 (area under the curve = .75), a minimum detectable change of 8, and a minimal clinically important difference of 5 were found. For the Importance subscale, a cut point of 39 (area under the curve = .81), a minimum detectable change of 8, and a minimal clinically important difference of 5 were found. CONCLUSIONS: The cut points resulted in good classification accuracy, providing support for their reliability. The results provided evidence that both subscales are sensitive to change in adults with brain injury.

Racial Variation in the Association Between Domains of Depressive Symptomatology and Functional Recovery in Stroke Survivors.

OBJECTIVE: The purpose of the study was to investigate the relationships between various domains of depressive symptomatology and functional recovery in Black and White stroke survivors. METHODS: Black (n = 181) and White (n = 797) stroke survivors from the Stroke Recovery in Underserved Population database were included. Four domains of depressive symptomatology (depressed affect, positive affect, somatic symptoms, interpersonal difficulties) were measured by the Center for Epidemiologic Studies Depression Scale at discharge; functional recovery was measured by the Functional Independence Measure at discharge and 3-month follow-up. Multivariable linear regression analyses examined the relation between race and functional recovery, and the association between depressive symptomatology and functional recovery by race. RESULTS: Three-month functional recovery was greater among White stroke survivors than Black survivors. Affective symptoms of depression predicted poorer functional recovery of White survivors; whereas somatic symptoms predicted poorer functional recovery of Black survivors. CONCLUSIONS: Domains of depressive symptomatology were differentially associated with poorer functional recovery in Black and White stroke survivors. Psychosocial interventions aimed at alleviating depressive symptomatology have the potential to improve functional recovery in Black and White stroke survivors and should be addressed in planning rehabilitation post-stroke.

The Moderating Role of Motivation in the Real-Time Associations of Fatigue, Cognitive Complaints, and Pain With Depressed Mood Among Stroke Survivors: An Ecological Momentary Assessment Study.

OBJECTIVE: Stroke symptoms fluctuate during the day as stroke survivors participate in daily activities. Understanding the real-time associations among stroke symptoms and depressed mood, as well as the role of motivation for daily activities, informs, and post-stroke symptom management in the context of everyday living. This study aimed to (1) investigate the real-time associations of fatigue, cognitive complaints, and pain with depressed mood and (2) examine the role of motivation for daily activity participation as a potential moderator of these associations in stroke survivors. DESIGN: A prospective cohort study involving 7 days of ecological momentary assessment (EMA), during which participants completed 8 EMA surveys per day. Multilevel modeling was used to analyze data. SETTING: Community. PARTICIPANTS: Forty community-dwelling stroke survivors (N=40). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: EMA measures of depressed mood, stroke symptoms (physical and mental fatigue, cognitive complaints, and pain), and motivation (autonomous motivation, controlled motivation). RESULTS: Higher levels of within- and between-person physical fatigue, mental fatigue, cognitive complaints, and pain were momentarily associated with greater depressed mood (Ps<.001). Within-person autonomous motivation significantly buffered the momentary associations of physical fatigue (B=-0.06, P<.001), mental fatigue (B=-0.04, P=.032), and pain (B=-0.21, P<.001) with depressed mood. CONCLUSIONS: Findings indicate the momentary associations of fatigue, cognitive complaints, and pain with depressed mood in stroke survivors. Autonomous motivation underpinning daily activity participation was found to buffer the associations of fatigue and pain with depressed mood. Promoting autonomous motivation for daily activity participation may be viable for preventing and mitigating poststroke depression.

Associations Between Basic Psychological Need Satisfaction and Motivation Underpinning Daily Activity Participation Among Community-Dwelling Survivors of Stroke: An Ecological Momentary Assessment Study.

OBJECTIVE: Grounded in the self-determination theory (SDT), this study aimed to examine the real-time associations between basic psychological need satisfaction and motivation underpinning daily activity participation among survivors of stroke. DESIGN: Repeated-measures observational study involving 7 days of ambulatory monitoring; participants completed ecological momentary assessment (EMA) surveys via smartphones 8 times daily. Multilevel models were used to analyze EMA data for concurrent (same survey) and lagged (next survey) associations. SETTING: General community. PARTICIPANTS: Forty community-dwelling survivors of stroke (N=40). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: EMA measures of basic psychological needs (autonomy, competence, relatedness) and motivation (autonomous motivation, controlled motivation). RESULTS: In concurrent analyses, increased autonomy (B=0.21; 95% confidence interval, 0.16-0.26; P<.001), competence (B=0.10; 95% confidence interval, 0.02-0.19; P=.021), and relatedness (B=0.10; 95% confidence interval, 0.06-0.13; P<.001) were momentarily associated with higher autonomous motivation. Conversely, increased autonomy (B=-0.19; 95% confidence interval, -0.27 to -0.10; P<.001) and competence (B=-0.09; 95% confidence interval, -0.17 to -0.01; P=.020) were momentarily associated with lower controlled motivation. Contrary to SDT, increased relatedness was momentarily associated with higher controlled motivation (B=0.10; 95% confidence interval, 0.05-0.14; P<.001). In lagged analyses, no momentary associations were detected between basic psychological needs and motivation (Ps>.05). CONCLUSIONS: Findings suggest that basic psychological need satisfaction is momentarily associated with motivation for daily activity participation. Additional research is warranted to examine the associations of different orientations of relatedness with autonomous and controlled motivation. Supporting basic psychological needs may foster autonomous motivation of survivors of stroke to enhance daily activity participation after stroke.

Cognition and Daily Life Activities in Stroke: A Network Analysis.

Understanding complex dynamics of cognitive constructs and the interplay between cognition and daily life activities is possible through network analysis. The objectives of this study are to characterize the cognition network and identify central cognitive constructs, and identify the cognitive constructs bridging cognition and daily life activities. In 210 community-dwelling stroke survivors, we employed network analysis to characterize the cognition network, identify the central cognitive constructs, and examine the bridge pathway connecting cognition and daily life activities. Cognitive constructs were positively correlated within the network, forming clusters of fluid (e.g., components of active problem-solving), crystallized (e.g., world knowledge), and functional cognition. Central constructs included inhibition, organization, and cognitive flexibility, whereas bridge constructs included organization, sequencing, and inhibition. Central and bridge constructs identified by this study are potential targets for future research and intervention. The emergence of functional cognition as central and bridge constructs may support its inclusion in occupational therapy practice.