Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 21

J Rehabil Med 2019; 51: 18–25 ORIGINAL REPORT PSYCHOLOGICAL FACTORS AFTER STROKE: ARE THEY STABLE OVER TIME? Melloney L. M. WIJENBERG, MSc 1,2 , Caroline M. VAN HEUGTEN, PhD 1–3 , Maria L. VAN MIERLO, PhD 4,5 , Johanna M. A. VISSER-MEILY, PhD 4 and Marcel W. M. POST, PhD 4,6 From the 1 Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, 2 Limburg Brain Injury Center, 3 Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 4 Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, 5 Clinical Research Department, Rijnstate Hospital, Arnhem and 6 Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Objective: Psychological factors influence stroke outcomes, such as participation and quality of life. Although important for clinical practice, not much is known about the temporal stability of these factors. This study explored whether psychological factors are stable post-stroke. Methods: Prospective longitudinal cohort study. The following psychological factors were assessed using self-report questionnaires at 2 months and at 2 years post-stroke: proactive coping, self-efficacy, extraversion, optimism, passive coping, neuroticism and pessimism. Changes over time, associations and dimensions among psychological factors were con- sidered. Results: Data for 324 participants were available. Only passive coping scores showed no change bet- ween 2 months and 2 years post-stroke. Participants showed less proactive coping, lower self-efficacy, less extraversion, less optimism, more neuroticism and more pessimism over time. All but one inter-cor- relation of psychological factors, r = [–0.14; 0.71], and all correlations over time, r = [0.42–0.64], were significant. At both time-points, the psychological factors clustered into an “adaptive psychological factor” (proactive coping, self-efficacy, extraversi- on) and a “maladaptive psychological factor” (pas- sive coping, neuroticism). Conclusion: Across all psychological factors, changes toward less favourable scores were found. Clinicians should pay attention to adaptive and maladaptive psychological factors among stroke patients during long-term care. Key words: stroke; psychological factors; rehabilitation; longitudinal studies. Accepted Aug 7, 2018; Epub ahead of print Oct 26, 2018 J Rehabil Med 2019; 51: 18–25 Correspondence address: Caroline M. van Heugten, NP&PP, FPN, Maastricht University, PO Box 616, 6200 MD Maastricht, The Nether- lands. E-mail: [email protected] S troke is a major health problem due to its high prevalence, disabling consequences and risk of recurrence (1). According to the International Clas- sification of Disability, Functioning and Health (ICF), functioning and health are influenced by personal LAY ABSTRACT Every person has a distinct personality. Personality traits may influence how people recover from stroke. This study followed 324 patients in the first 2 years after stroke and examined whether these personality traits are stable over time. We found changes to less favoura- ble outcomes, such as less extraversion, less optimism and more neuroticism. Clinicians should be aware of these changes and stimulate the use of more adaptive psychological factors, such as proactive coping and op- timism. factors, including psychological factors (2). Examp- les of psychological factors are proactive coping, self-efficacy, extraversion, optimism, passive coping, neuroticism and pessimism. In stroke, specifically, previous research has revealed associations between psychological factors and parti- cipation or quality of life (3–5). Research has shown that proactive coping, self-efficacy, extraversion and optimism are related to better outcomes, whereas pas- sive coping, neuroticism and pessimism are related to worse outcomes (3–7). These strong associations with outcome highlight the importance of gaining knowled- ge about the properties of these psychological factors, such as their stability after stroke. Knowledge about temporal stability can be used to optimize the timing of psychological assessments and to gain knowledge about whether these factors can be influenced in such a way that outcome can be optimized. In healthy people psychological factors, especially personality traits, are generally regarded as stable (8). Most studies confirm the temporal stability among psychological factors in healthy adults (9–13), but a few studies have reported changes over time, in e.g. optimism (14) and neuroticism (10, 12). Studies in patients with stroke and similar neurological condi- tions, such as traumatic brain injury (TBI), have shown mixed findings. Regarding personality traits, inconsis- tent results across and within factors have been found, and specific evidence remains scarce for patients with stroke (11, 12, 15–17). These inconsistencies are also found with regard to coping (3, 17, 18), possibly also because terminology for subtypes of coping styles differ widely (19). This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2488 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977