Exploring the dynamics of stroke survivors’ care dependency, fatigue, and coping strategy in their caregivers: a structural equation modeling analysis

None of these problems need to occur if we have EXACT 100% RECOVERY PROTOCOLS! And I bet your incompetent? doctor is not working on 100% recovery! I'd have everyone fired who is not working on 100% recovery! A lot of dead wood needs to be removed in stroke, put survivors in charge and it will get done.

Exploring the dynamics of stroke survivors’ care dependency, fatigue, and coping strategy in their caregivers: a structural equation modeling analysis

Jinyao Wang1†, Shuangyan Tu2†, Jun Cui3, Rong Yang2, Yan Jiang4* and Lihong Zhao5*

1DWest China School of Nursing, Sichuan University/Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China

2Department of Neurology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China

3Department of Infrastructure, West China Hospital, Sichuan University, Chengdu, China

4Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China

5Department of Radiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China

Edited by

Thao Thi Phuong Nguyen, Vinmec Research Institute of Stem Cell and Gene Technology, Vietnam

Reviewed by

Kristopher Struckmeyer, The Pennsylvania State University (PSU), United States

Donna de Levante Raphael, Alzheimer’s Foundation of America, United States

*Correspondence

Yan Jiang, hxhljy2018@163.com; Lihong Zhao, hxzlh2021@163.com

†These authors have contributed equally to this work

Received 14 November 2024

Accepted 07 May 2025

Published 21 May 2025

Citation

Wang JY, Tu SY, Cui J, Yang R, Jiang Y and Zhao LH (2025) Exploring the dynamics of stroke survivors’ care dependency, fatigue, and coping strategy in their caregivers: a structural equation modeling analysis. Front. Public Health 13:1528109. doi: 10.3389/fpubh.2025.1528109

Aims: To evaluate the interactions among stroke survivors’ care dependency, caregivers’ negative coping strategy, and fatigue.

Design: Descriptive quantitative research design.

Setting: Patients with acute stroke and their caregivers were enrolled in a General Hospital in West China from July 2022 to April 2023.

Primary and secondary outcome measures: Data collection adopted the Care Dependency Scale (CDS), the Simple Coping Style Questionnaire (SCSQ), and the Fatigue Scale-14 (FS-14). Structural equation modeling was applied to test the hypothetical model. This study adhered to STROBE reporting guidelines.

Results: A total of 380 dyads with the mean age of stroke caregivers was 63.41 ± 12.87 years. The mean score for care dependency, fatigue, positive coping, and negative coping were 53.91 ± 15.95, 8.34 ± 3.58, 19.39 ± 7.05, and 8.06 ± 4.23, respectively. The structural equation model had a good fit index (χ2 = 12.595 (df 5), IFI = 0.993, GFI = 0.990, AGFI = 0.956, NFI = 0.988, TLI = 0.979, CFI = 0.993, RMSEA = 0.063, SRMR = 0.0213). It showed that the direct effect path coefficients of patients’ care dependency on caregivers’ fatigue (β = −0.22, 95% confidence interval (CI): −0.367, −0.097, p = 0.002) and negative coping (β = −0.31, 95% CI: −0.438, −0.155, p = 0.003) were statistically significant. The NIHSS score indirectly influenced caregivers’ fatigue (β = 0.023, 95% CI: 0.006, 0.051, p = 0.002) and negative coping (β = 0.204, 95% CI: 0.103, 0.303, p = 0.003) through the mediating effect of care dependency.

Lifestyle Linked to Alzheimer’s Risk

I think I have excellent coping skills, vastly proven by coping with this fucking stroke with essentially no help from most of my stroke medical professionals.  My OT was great, she really knew her stuff. 

Lifestyle Linked to Alzheimer’s Risk

Researchers in the US have announced new findings which highlight factors that could affect the risk of memory problems as we age.
The investigators analysed data from the Einstein Aging Study, a project which has monitored the memory and thinking ability of older people living in a particular borough of New York since the 1980s. Scientists presented a number of findings based on work done with the Einstein Ageing Study at this week’s Alzheimer’s Association International Conference in Washington, D.C.
Much of the work relates to amnestic mild cognitive impairment (aMCI) – memory and thinking problems which are less severe than dementia but often precede the condition. It can be difficult to distinguish normal age-related memory changes from aMCI, and doctors need new ways to reliably identify people with the condition. The researchers suggested that subtle differences in an aspect of memory called memory binding could help identify healthy older people at a higher risk of developing aMCI and dementia. They found that people with lower scores on the Memory Biding Test could be 2.5 times more likely to develop aMCI. The presentations also highlighted research suggesting that certain people who feel more stressed, and individuals with poorer coping skills may be at an increased risk of developing aMCI.
Other research with the Einstein Aging Study aimed to determine whether rates of dementia might be changing over time. Looking at people in the study born between 1916 and 1935, the researchers showed that those born after 1930 had an 18% reduction in their risk of developing dementia – indicating that dementia rates could be falling. They propose that this lower risk may be due to improvements in the way high blood pressure or diabetes are managed, both risk factors for dementia.

he researchers suggested that subtle differences in an aspect of memory called memory binding could help identify healthy older people at a higher risk of developing aMCI and dementia. Image is for illustrative purposes only.

Dr Eric Karran, Director of Research at Alzheimer’s Research UK said:
“This work with the Einstein Aging Study highlights some interesting areas for future research. Studies that follow large groups of people over long periods of time are important as they allow researchers to unpick lifestyle factors that can affect brain health as people get older, and reveal how the impact of dementia might be changing over time. Alzheimer’s Research UK is proud to be investing £3m in a longitudinal study looking at the risk factors for dementia in the UK’s longest running birth cohort.
“Previous large scale research studies have shown that eating a balanced diet, drinking in moderation, keeping blood pressure and cholesterol in check, and staying mentally and physically active can all help to lower our risk of memory problems as we age. While it will never be possible to completely prevent dementia, if everyone was encouraged to adopt these positive lifestyle choices, we could expect to see a reduction in the proportion of people who develop dementia.”

The effect of implication of the Mauk nursing rehabilitation model (Agonizing phase، Fantasy phase، Realizing phase) on the coping strategies of stroke patients

I've not heard of this but I do remember fantasizing  being fully athletic again.
Mauk model defined here.
http://irj.uswr.ac.ir/browse.php?a_code=A-10-346-1&slc_lang=en&sid=en

Author(s): Maryam Shoja, Asghar Dalvandi *, Hamid reza Khakeh, Abbas Tafakhori, Payam Sarraf, Roozbeh Kazemi, Zeinab Ebrahimpour, Akbar Biglarian , Kristin L Mauk

, asghar.dalvandi@gmail.com

Study Type: Original Research Articles | Subject: clinical and basic research

Article abstract:

Objectives: Stroke is a major event in one's life that patients will inevitably require the use of coping strategies in order to try to reestablish acceptable life equilibrium. Due to the extensive role that have nurses can be active members in the patient's rehabilitation plan. mauk model is a model that focuses on stroke patients. Mauk for each stage of this model has developed appropriate rehabilitation nursing interventions.This study aimed to The effect of implication of the Mauk nursing rehabilitation model(Agonizing phase، Fantasy phase، Realizing phase) on the coping strategies of stroke patients. METHOD: This study is a quasi-experimental one-group pre-test - post-test. The interventions, identify and learning coping strategies for patients based on the Mauk model. The convenience sampling was done and was performed in Emam hospital and Tabassom rehabilitation center in 1392. Data collection instruments, was demographic questionnaire and coping strategies questionnaire for stroke patients .The educational program was implemented in six sessions 45-minute.The patients Coping strategies, before and after of training was assessed. Data was statistically analyzed using descriptive and inferential tests in the SPSS software. Results:The mean score for coping strategiesbefore intervention was 111/42 ±11/71and after intervention was102/14± 12/45(p<0/05). The physical, mental and social dimensions in the coping strategies showed significant differences between other aspects of the questionnaire. Conclusion:Using the Mauk rehabilitation model intervention for effective dealing with the stress and changing behavior patterns unpredictable with the health with biological treatment for chronic patients is an important component of the treatment protocol,and cause increase coping strategies in stroke patients.

High stress, hostility, depression linked with increased stroke risk

You will need to demand that your doctor reduce your stress about recovering by laying out an exact plan and protocols to get to 100% recovery. Also take those anti-depressants which are so good for your stroke recovery.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=143534&CultureCode=en
Higher levels of stress, hostility and depressive symptoms are associated with significantly increased risk of stroke or transient ischemic attack (TIA) in middle-age and older adults, according to new research in the American Heart Association journal Stroke.
A TIA is a stroke caused by a temporary blockage of blood flow to the brain.
Researchers investigated how psychological factors might influence risk for chronic disease, using data from the Multi-Ethnic Study of Atherosclerosis (MESA), an ongoing study on cardiovascular disease risk factors in participants living in six U.S. cities.
More than 6,700 adults (ages 45-84; 53 percent women) completed questionnaires assessing chronic stress, depressive symptoms, anger and hostility over two years. Participants were 38.5 percent white, 27.8 percent African-American, 11.8 percent Chinese and 21.9 percent Hispanic. All were free of cardiovascular disease at the start of the study.
In follow-up for an additional 8.5 to 11 years, 147 strokes and 48 TIAs occurred.
Compared to people with the lowest psychological scores, those with highest scores were:

• 86 percent more likely to have a stroke or TIA for high depressive symptoms.
• 59 percent more likely to have a stroke or TIA for the highest chronic stress scores.
• More than twice as likely to have a stroke or TIA for the highest hostility scores.

No significant increased risk was linked to anger.
“There’s such a focus on traditional risk factors — cholesterol levels, blood pressure, smoking and so forth — and those are all very important, but studies like this one show that psychological characteristics are equally important,” said Susan Everson-Rose, Ph.D., M.P.H., study lead author and associate professor of medicine at the University of Minnesota in Minneapolis.
These associations noted in the study were significant even when researchers accounted for age, race, sex, health behaviors and other known risk factors of stroke.
“Given our aging population, it’s important to consider these other factors that might play a role in disease risk. Stroke is a disease of the elderly predominantly, and so learning more about things that can influence risk for stroke as people age is important.”
Researchers measured chronic stress in five domains: personal health problems, health problems of others close to the participant, job or ability to work, relationships and finances.
They assessed depressive symptoms with a 20-question scale and analyzed anger with a 10-item scale that captured the extent and frequency of experiencing that emotion. Hostility, which is a negative way of viewing the world, was measured by assessing a person’s cynical expectations of other people’s motives.
“One thing we didn’t assess is coping strategies,” Everson-Rose said. “If someone is experiencing depressive symptoms or feeling a lot of stress or hostility, we don’t know how they manage those, so it’s possible that positive coping strategies could ameliorate some of these associations or effects,” she said. “We did not inquire about coping. I would say that’s one of the tasks for future studies.”
Researchers didn’t identify potential racial and ethnic differences or sex differences in the observed associations, but were not able to fully examine such differences due to the smaller numbers of strokes in some groups.
Co-authors are Nicholas Roetker, B.A.; Pamela Lutsey, Ph.D., M.P.H.; Kiarri Kershaw, Ph.D., M.P.H.; W.T. Longstreth Jr., M.D., M.P.H.; Ralph Sacco, M.D., M.S.; Ana Diez Roux, M.D., Ph.D., M.P.H.; Alvaro Alonso, M.D., Ph.D. Author disclosures are on the manuscript.

Coping During Inpatient Stroke Rehabilitation: An Exploratory Study

I had zilch on coping with the effects of the stroke. I think the thought was; don't tell him how bad this is because he might not handle it ok.
http://ajot.aotapress.net/content/60/2/136.short

1. Glen Gillen

+ Author Affiliations

1. Glen Gillen, EdD, OTR, FAOTA, is Assistant Professor in Clinical Occupational Therapy, Programs in Occupational Therapy, 710 West 168th Street, 8th Floor, New York, New York 10032; GG50@columbia.edu

Abstract

The emotional impact of surviving a stroke has not received the same attention as physical aspects. This is particularly true regarding how stroke survivors cope during inpatient rehabilitation. This study examined the coping strategies used by stroke survivors undergoing inpatient rehabilitation and the relationships between demographic or clinical variables and coping behaviors. This case series examined 16 acute stroke survivors via standardized assessments and a medical records review completed during the first week of inpatient rehabilitation.

Stroke survivors used combinations of multiple coping strategies. All stroke survivors used a higher number and frequency of adaptive rather than maladaptive strategies. Women used a higher number of adaptive strategies. Stroke survivors with depression used maladaptive coping strategies more frequently, whereas those presenting with a greater number and severity of comorbidities used adaptive coping strategies more frequently. Stroke survivors with higher levels of coping self-efficacy used the strategies of active coping and positive reframing more frequently.

Based on these results, it is recommended direct-care providers place greater emphasis on objectifying the emotional consequences of stroke. Further research is recommended regarding understanding the relationship between coping and outcomes.

The effectiveness of problem solving therapy for stroke patients: study protocol for a pragmatic randomized controlled trial

If you were smart you would realize that the whole problem here is that survivors have a small chance of full recovery  using current methods. Making them feel better about the lack of recovery is not useful. Go back and start figuring out how to reduce disability in the first place by maybe using one of these 177 hyperacute therapies.

This is just another version of getting better at breaking bad news.
 http://7thspace.com/headlines/440170/the_effectiveness_of_problem_solving_therapy_for_stroke_patients_study_protocol_for_a_pragmatic_randomized_controlled_trial.html
Coping style is one of the determinants of health-related quality of life after stroke. Stroke patients make less use of active problem-oriented coping styles than other brain damaged patients.

Coping styles can be influenced by means of intervention. The primary aim of this study is to investigate if Problem Solving Therapy is an effective group intervention for improving coping style and health-related quality of life in stroke patients.

The secondary aim is to determine the effect of Problem Solving Therapy on depression, social participation, health care consumption, and to determine the cost-effectiveness of the intervention.

Methods: We strive to include 200 stroke patients in the outpatient phase of rehabilitation treatment, using a multicenter pragmatic randomized controlled trial with one year follow-up. Patients in the intervention group will receive Problem Solving Therapy in addition to the standard rehabilitation program.

The intervention will be provided in an open group design, with a continuous flow of patients. Primary outcome measures are coping style and health-related quality of life.

Secondary outcome measures are depression, social participation, health care consumption, and the cost-effectiveness of the intervention.DiscussionWe designed our study as close to the implementation in practice as possible, using a pragmatic randomized trial and open group design, to represent a realistic estimate of the effectiveness of the intervention. If effective, Problem Solving Therapy is an inexpensive, deliverable and sustainable group intervention for stroke rehabilitation programs.Trial registration: Nederlands Trial Register, NTR2509