Intraindividual variability in post-stroke cognition and its relationship with activities of daily living and social functioning: an ecological momentary assessment approach.
Elizabeth G S Munsell, Quoc Bui, Katherine J Kaufman, Stephanie E Tomazin, Bridget A Regan, Eric J Lenze, Jin-Moo Lee, David C Mohr, Mandy W M Fong, Christopher L Metts, Vy Pham, Alex W K Wong
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引用次数: 0
Abstract
Introduction: Ecological momentary assessment (EMA) is a methodological approach to studying intraindividual variation over time. This study aimed to use EMA to determine the variability of cognition in individuals with chronic stroke, identify the latent classes of cognitive variability, and examine any differences in daily activities, social functioning, and neuropsychological performance between these latent classes.
Methods: Participants (N = 202) with mild-to-moderate stroke and over 3-month post-stroke completed a study protocol, including smartphone-based EMA and two lab visits. Participants responded to five EMA surveys daily for 14 days to assess cognition. They completed patient-reported measures and neuropsychological assessments during lab visits. Using latent class analysis, we derived four indicators to quantify cognitive variability and identified latent classes among participants. We used ANOVA and Chi-square to test differences between these latent classes in daily activities, social functioning, and neuropsychological performance.
Results: The latent class analysis converged on a three-class model. The moderate and high variability classes demonstrated significantly greater problems in daily activities and social functioning than the low class. They had significantly higher proportions of participants with problems in daily activities and social functioning than the low class. Neuropsychological performance was not statistically different between the three classes, although a trend approaching statistically significant difference was observed in working memory and executive function domains.
Discussion: EMA could capture intraindividual cognitive variability in stroke survivors. It offers a new approach to understanding the impact and mechanism of post-stroke cognitive problems in daily life and identifying individuals benefiting from self-regulation interventions.
简介生态瞬间评估（EMA）是一种研究个体内部随时间变化的方法。本研究旨在使用 EMA 确定慢性中风患者认知的变异性，识别认知变异性的潜在类别，并研究这些潜在类别之间在日常活动、社会功能和神经心理学表现方面的差异：方法：轻度至中度中风且中风后超过 3 个月的参与者（N = 202）完成了一项研究方案，包括基于智能手机的 EMA 和两次实验室访问。参与者在 14 天内每天回答五次 EMA 调查，以评估认知能力。在实验室访问期间，他们完成了患者报告测量和神经心理学评估。通过潜类分析，我们得出了量化认知变异性的四个指标，并确定了参与者之间的潜类。我们使用方差分析和卡方检验了这些潜类在日常活动、社会功能和神经心理学表现方面的差异：潜类分析得出了一个三类模型。中度和高度变异等级在日常活动和社会功能方面的问题明显多于低度等级。在日常活动和社会功能方面出现问题的参与者比例明显高于低变异等级。虽然在工作记忆和执行功能领域观察到了接近统计学显著差异的趋势，但三个等级之间的神经心理学表现并无统计学差异：讨论：EMA 可以捕捉中风幸存者个体内部的认知差异。讨论：EMA 可以捕捉脑卒中幸存者个体内部的认知变异，为了解脑卒中后认知问题在日常生活中的影响和机制以及识别从自我调节干预中受益的个体提供了一种新方法。
期刊介绍：
Topics in Stroke Rehabilitation is the leading journal devoted to the study and dissemination of interdisciplinary, evidence-based, clinical information related to stroke rehabilitation. The journal’s scope covers physical medicine and rehabilitation, neurology, neurorehabilitation, neural engineering and therapeutics, neuropsychology and cognition, optimization of the rehabilitation system, robotics and biomechanics, pain management, nursing, physical therapy, cardiopulmonary fitness, mobility, occupational therapy, speech pathology and communication. There is a particular focus on stroke recovery, improving rehabilitation outcomes, quality of life, activities of daily living, motor control, family and care givers, and community issues.
The journal reviews and reports clinical practices, clinical trials, state-of-the-art concepts, and new developments in stroke research and patient care. Both primary research papers, reviews of existing literature, and invited editorials, are included. Sharply-focused, single-issue topics, and the latest in clinical research, provide in-depth knowledge.
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