Topics in Stroke Rehabilitation最新文献

{"title":"Relationship between diaphragmatic muscle function and urinary incontinence in individuals with stroke: a prospective observational study.","authors":"Yunus Emre Tütüneken, Özge Çakmak, Berfin Demir, Sıla Yağmur Yildirim, Edanur Anlar, Muhammed Emin Özkul","doi":"10.1080/10749357.2026.2634288","DOIUrl":"10.1080/10749357.2026.2634288","url":null,"abstract":"<p><strong>Background: </strong>Weakness in respiratory muscles following a stroke may hinder the regulation of intra-abdominal pressure, potentially escalating the risk and severity of urinary incontinence (UI). A thorough understanding of how respiratory muscle strength and diaphragm function relate to UI in stroke patients is essential for comprehensive clinical assessment.</p><p><strong>Objectives: </strong>This study aimed to explore the connection between maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), diaphragm function, and symptoms of urinary incontinence in stroke patients.</p><p><strong>Methods: </strong>Fifty stroke patients (mean age 60.16 ± 9.56 years; 74% male) participated in the study. Respiratory muscle strength was assessed through standardized measurements of MIP and MEP. Endurance was evaluated with the Inspiratory Threshold Load (ITL) test. The effect of UI on quality of life was assessed using the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Diaphragm function was measured with specific tests based on the Dynamic Neuromuscular Stabilization (DNS) method. Differences between symptomatic and asymptomatic groups were analyzed using Pearson correlation, independent t-tests, Mann-Whitney U tests, and chi-square tests.</p><p><strong>Results: </strong>Significant negative correlations were found between MIP and ITL scores and the severity of urinary incontinence (<i>p</i> < 0.001), while MEP exhibited weaker but still significant correlations (<i>p</i> < 0.05). Patients with urinary incontinence demonstrated significantly reduced diaphragm function compared to their asymptomatic counterparts (<i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>In individuals with stroke, diminished respiratory muscle strength, particularly diaphragm dysfunction, is linked to increased severity of UI. These findings highlight the necessity of evaluating respiratory muscle function in this population.</p><p><strong>Registration no: </strong>NCT07048210.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"734-743"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of quantity of caregiving for stroke survivors: who receives the most informal caregiving hours per week.","authors":"Aileen Chou, Scott R Beach, Barbara J Lutz, Juleen Rodakowski, Lauren Terhorst, Janet K Freburger","doi":"10.1080/10749357.2026.2641749","DOIUrl":"10.1080/10749357.2026.2641749","url":null,"abstract":"<p><strong>Background: </strong>Stroke survivors often depend on caregivers for assistance with activities of daily living (ADL), yet it remains unclear which individuals receive more assistance long-term. We examined predictors of the quantity of informal caregiving in the first year following their stroke.</p><p><strong>Methods: </strong>Data from the National Health and Aging Trends Study (2011-2020, <i>n</i> = 578) was used in this retrospective cohort study of older adults. Individuals with at least 1 formal or informal caregiver who reported an incident stroke were included. Multivariate negative binomial regression analyses identified informal caregiver and stroke survivor characteristics associated with the quantity of informal caregiving received. Regression coefficients were converted to average marginal effect (AME) to describe the predicted number of informal caregiving hours.</p><p><strong>Results: </strong>Community-dwelling stroke survivors received a median of 15.2 (IQR, 4.1-47.0) hours/week of informal caregiving from an average of 2.3 (SD 1.4) informal caregivers within one-year of an incident stroke. Stroke survivors who were males, married, had more physical and cognitive impairments received more informal caregiving. Relative to individuals with 0-1 ADL limitations receiving 10 informal care hours/week, on average, those with 5-7 ADL limitations received 2.7 more hours/week (AME: 2.65, 95% CI: 1.47-3.83); <i>p</i> < 0.001). Subgroups of non-White stroke survivors and those with primary caregivers tend to receive more informal care than White stroke survivors and those with shared caregivers, respectively.</p><p><strong>Conclusion: </strong>Within this nationally representative dataset, specific stroke survivor demographic and clinical variables were associated with high amounts of informal caregiving which may help inform policy and future interventions to effectively allocate resources and target high-need families.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"820-832"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A meta-analysis of the effect of evidence-based nursing for patients with ischemic stroke.","authors":"Jin Yan, Lei Hua, XiaoNi Li, MeiYan Jiao, WeiYan Shen","doi":"10.1080/10749357.2026.2634284","DOIUrl":"10.1080/10749357.2026.2634284","url":null,"abstract":"<p><strong>Objectives: </strong>The efficacy of evidence-based nursing in ischemic stroke patients remains debated. Therefore, this meta-analysis compared the efficacy of evidence-based nursing with that of usual care in terms of quality of life and psychological outcomes after ischemic stroke.</p><p><strong>Methods: </strong>We searched the Cochrane Library, Web of Science, PubMed, and Scopus from the inception to 20 February 2025 to identify articles comparing the efficacy of evidence-based nursing with that of usual care among those experiencing ischemic stroke. We used the revised Cochrane risk-of-bias tool for randomized trials (RoB2) to assess the risk of bias.</p><p><strong>Results: </strong>Finally, 10 articles with 1645 participants in the usual care group and 1481 participants in the evidence-based nursing group were included in this meta-analysis. Compared to usual nursing, evidence-based nursing did not significantly change the Barthel index (SMD 0.61, 95% CI (-0.34, 1.55), I² = 95.79%), SP-36 physical component score (SMD 0.40, 95% CI (-0.52, 1.33), I² = 98.25%), SP-36 mental component score (SMD 0.39, 95% CI (-0.46, 1.25), I² = 97.93%), World Health Organization quality of life brief version (WHOQOL-BREF) physical component score (SMD 0.90, 95% CI (-0.90, 2.70), I² = 98.60%), WHOQOL-BREF mental component score (SMD 0.61, 95% CI (-0.31, 0.52), I² = 94.81%), and self-rating anxiety scale (SAS) score (SMD -5.78, 95% CI (-15.73, 4.18), I² = 99.89%), but significantly reduced self-rating depression scale (SDS) score (SMD -1.77, 95% CI (-2.49, -1.05), I² = 87.00%), highlighting the potential benefits of evidence-based nursing in stroke patients with depressed mood.</p><p><strong>Conclusion: </strong>Among patients with ischemic stroke, evidence-based nursing was not significantly superior to usual nursing in most assessment tests.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"810-819"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of resting muscle tone and stiffness in acute stroke survivors: which muscles' tone correlates with trunk control? a cross-sectional study.","authors":"Hakan Polat, Tuba Maden, Yasemin Ekmekyapar Fırat","doi":"10.1080/10749357.2026.2651793","DOIUrl":"10.1080/10749357.2026.2651793","url":null,"abstract":"<p><strong>Background: </strong>Trunk control is an early predictor of functional and motor recovery in acute ischemic stroke (AIS). Although changes in muscle tone and stiffness post-stroke are well documented, their relationship with trunk control remains underexplored.</p><p><strong>Objective: </strong>To identify which trunk muscles' resting tone and stiffness are most strongly correlated with trunk control in AIS survivors.</p><p><strong>Methods: </strong>Thirty AIS survivors (time from symptom onset ≤72 hours) were included in this cross-sectional study. Trunk control and global disability were assessed using the Trunk Impairment Scale (TIS) and modified Rankin Scale (mRS), respectively. MyotonPRO® was used to measure tone and stiffness of the Longissimus Thoracis (LT), Lumbar Multifidus (LM), Trapezius (T), and Rectus Femoris (RF) muscles. Pearson's correlation and multiple linear regression analyses were performed.</p><p><strong>Results: </strong>TIS scores correlated strongly with LT tone (<i>r</i> = 0.604, <i>p</i> < 0.001), LT stiffness (<i>r</i> = 0.648, <i>p</i> < 0.001), and LM stiffness (<i>r</i> = 0.619, <i>p</i> < 0.001), and moderately with LM tone (<i>r</i> = 0.410, <i>p</i> = 0.012), but not with Trapezius tone (<i>p</i> = 0.092) or RF stiffness (<i>p</i> = 0.305). LT stiffness showed a strong negative correlation with mRS grade (<i>r</i> = -0.648, <i>p</i> < 0.001). Regression analysis identified LT tone (R² = 0.318, <i>p</i> = 0.008) and LT stiffness (R² = 0.432, <i>p</i> = 0.001) as significant independent predictors of trunk control.</p><p><strong>Conclusions: </strong>Resting tone and stiffness of the LT are associated with trunk control and global disability in AIS survivors. Higher LT stiffness predicts better trunk control and lower disability, suggesting its potential as an early marker of functional recovery.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov (NCT06006988).</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"800-809"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A feasibility study of a home-based ballet-inspired workout program to improve post-stroke physical and cognitive outcomes.","authors":"Suzanne Hoi Shan Lo, Janita Pak Chun Chau, Kai Chow Choi, Laveeza Butt, Jonas Hon Ming Yeung, Siu Hung Li, Marika Demers","doi":"10.1080/10749357.2026.2634290","DOIUrl":"10.1080/10749357.2026.2634290","url":null,"abstract":"<p><strong>Background: </strong>Balancing problems and memory loss are common in people after stroke. Growing evidence shows that dance-based interventions may improve the outcomes of gait, stability and cognitive functions among stroke survivors.</p><p><strong>Objectives: </strong>To establish the feasibility and preliminary effects of a home-based ballet-inspired workout program for stroke survivors.</p><p><strong>Methods: </strong>Thirty-two adults with a first-ever ischemic or hemorrhagic stroke were randomly assigned to the control or the intervention group, in which they completed an 8-week program grounded on Bandura's principles of self-efficacy and outcome expectation. The program was delivered by a lay volunteer and a peer volunteer, and supported by a registered nurse. Participants practiced eight ballet-inspired workouts, mental rehearsal, and signature dance through a mutually agreed goal and action plan. Feasibility (recruitment rate, attendance, and safety), and survivors' balance, balance confidence, gait, walking endurance, and memory were assessed at baseline and post-intervention. Individual semi-structured interviews were conducted to understand participants' and volunteers' experiences. Interview data were thematically analyzed. Bias-corrected Hedges' effect sizes were calculated.</p><p><strong>Results: </strong>Four participants were recruited per month on average over eight months. The participants had a mean age of 62.7 years (standard deviation (SD)=12.9)). The attendance rate was 100%. No adverse events were reported. Two themes were identified: mutual multi-faceted benefits, importance of ongoing support strategies and program tailoring. Though showing small effect sizes and non-significant between-group differences, participants in the intervention group improved in all outcomes.</p><p><strong>Conclusions: </strong>The ballet-inspired workout program was safe and feasible, and may improve stroke survivors' mobility, confidence, and cognitive outcomes.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"755-766"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric properties of the performance fatigue index in people with stroke.","authors":"Lily Y W Ho, Claudia K Y Lai, Shamay S M Ng","doi":"10.1080/10749357.2026.2648213","DOIUrl":"10.1080/10749357.2026.2648213","url":null,"abstract":"<p><strong>Background: </strong>The performance fatigue index provides objective measures for assessing the impact of fatigue on performance and it may be utilized for monitoring functional outcomes in individuals with stroke; however, its psychometric properties have been minimally studied in this population.</p><p><strong>Objectives: </strong>To examine the test-retest reliability and agreement; known-group validity of the performance fatigue index; and its correlations with self-perceived fatigue, depressive symptoms, sleep quality, and reintegration to normal living in people with stroke.</p><p><strong>Methods: </strong>Participants with and without stroke completed a 6-minute walk test for calculating the performance fatigue index. Participants with stroke also completed the Fatigue Assessment Scale, the Geriatric Depression Scale, the Pittsburgh Sleep Quality Index, and the Reintegration to Normal Living Index. The intra-class correlation coefficient, standard error of measurement, minimal detectable change, and known group validity of the performance fatigue index were determined. Spearman's correlation was used to examine the relationships between the index and other variables.</p><p><strong>Results: </strong>The intra-class correlation coefficient of the performance fatigue index was 0.99, the standard error of measurement was 0.53 and the minimal detectable change was 1.46. The performance fatigue index could be used to differentiate individuals with stroke from those without stroke. It significantly correlated with self-perceived physical fatigue subscore (r_s = 0.29, <i>p</i> = .034) and reintegration to normal living (r_s = -0.34, <i>p</i> = .012) but not correlated with self-perceived mental fatigue subscore, depressive symptoms, or sleep quality.</p><p><strong>Conclusion: </strong>The performance fatigue index is reliable and valid in assessing and monitoring post-stroke physical fatigue in clinical and research settings.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"779-788"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low levels of physical activity and high amount of sedentary behavior in the acute phase after stroke.","authors":"Gabriel Tafdrup Notkin, Dorthe Gaby Bove, Kai Jensen, Lisbet Lind, Julie Lyng Forman, Michael Broksgaard Jensen, Stig Molsted","doi":"10.1080/10749357.2026.2733382","DOIUrl":"https://doi.org/10.1080/10749357.2026.2733382","url":null,"abstract":"<p><strong>Background: </strong>Early rehabilitation and physical activity (PA) are crucial for patients with stroke to recover functional abilities and reduce cardiovascular risks. However, PA may be challenging post-stroke.</p><p><strong>Objectives: </strong>This study assessed PA levels during the acute post-stroke phase in patients referred to rehabilitation and examined the impact of demographic and clinical variables on PA.</p><p><strong>Methods: </strong>Participants were enrolled during acute hospital stays. PA was measured during admission and 7-days post‑discharge using SENS motion® sensor, categorized into steps, moderate-vigorous PA (MVPA), total PA, and sedentary time.</p><p><strong>Results: </strong>The participants (<i>n</i> = 95) were (mean ± SD) 71 ± 10 years; the median Scandinavian Stroke Scale score was 54 (IQR 46-58). From hospitalization to post‑discharge steps/day increased from 2844 [95% CI 2091; 3597] to 4970 [3790; 6150], <i>p</i> <0.001, MVPA from 1.7 [0.2; 3.2] to 3.8 [1.4; 6.2] minutes per day, <i>p</i> = 0.023, and sedentary time decreased from 22.7 [22.2; 23.1] to 21.1 [20.4; 21.8] hours per day, <i>p</i> <0.001.PA remained stable during hospitalization and after discharge, respectively, whereas sedentary time decreased post‑discharge from day 1-2 (21.6 [21.1; 22.8] to 21.0 [20.5; 21.5] hours/day), <i>p</i> <0.001, day 3-4 (20.8 [20.5; 21.3] to 20.7 [20.2; 21.3] hours/day), <i>p</i> = 0.043. Stroke severity was inversely associated with steps/day.</p><p><strong>Conclusions: </strong>Even though PA levels were elevated following discharge, the levels remained low during both periods. Whilst sedentary behavior declined slightly after discharge, it remained on a high amount. Steps per day were associated with less stroke severity.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"1-13"},"PeriodicalIF":2.3,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Content validation of a return-to-work cognitive intervention after stroke.","authors":"Nicole Yun Ching Chen, Pengxiang Xia, Sharmaine Pang, Yanhong Dong","doi":"10.1080/10749357.2026.2733383","DOIUrl":"10.1080/10749357.2026.2733383","url":null,"abstract":"<p><strong>Background: </strong>Return-to-work is a key recovery milestone for many stroke survivors. The Train-Your-Brain community-based return-to-work cognitive intervention program was developed to support this transition. As part of a co-design process, content validation was conducted to refine the intervention components and materials through stakeholder consultation.</p><p><strong>Objectives: </strong>This study aimed to conduct content validation of the intervention materials with key stakeholders. A secondary aim was to examine whether stakeholder-informed revisions improved material ratings.</p><p><strong>Methods: </strong>Fifteen stakeholders (five stroke survivors, five caregivers, and five healthcare professionals) participated in a two-round content validation process to evaluate the actionability, understandability, and satisfaction of the intervention materials. In the first round, participants completed an online survey and attended focus groups to provide feedback on content and design. Materials were revised over one month and reevaluated in a second round through a follow-up survey and focus group. Feedback from the second round was incorporated to finalize the intervention materials.</p><p><strong>Results: </strong>Among stroke survivors, positive trends were observed across all domains following revision, with medium-to-large effect sizes for satisfaction and understandability. Caregivers demonstrated significant improvements in actionability (<i>p</i> = .043) and understandability (<i>p</i> = .031). Healthcare professionals reported significant improvements in overall satisfaction (<i>p</i> = .041). Qualitative feedback further informed refinements to improve the materials.</p><p><strong>Conclusions: </strong>This study demonstrated that a stakeholder-driven content validation process can meaningfully enhance an intervention program as part of a co-design process. Stakeholders' revisions and input resulted in materials that are better aligned with lived experiences and user needs, which strengthened the intervention.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"1-10"},"PeriodicalIF":2.3,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Music-based interventions in adult stroke rehabilitation: a narrative review of clinical applications, proposed mechanisms, and implementation.","authors":"Xue Gong, Jingting Kong, Zixuan Zhang, Hua Sun","doi":"10.1080/10749357.2026.2733390","DOIUrl":"https://doi.org/10.1080/10749357.2026.2733390","url":null,"abstract":"<p><strong>Background: </strong>Music is used in stroke rehabilitation through therapist-delivered music therapy, neurologic music therapy techniques, other structured music-based interventions, and technology-assisted systems. Inconsistent terminology and overstated mechanisms complicate interpretation.</p><p><strong>Objectives: </strong>To synthesize the clinical applications, proposed mechanisms, limitations, and implementation considerations of music-based interventions in adult stroke rehabilitation.</p><p><strong>Methods: </strong>We conducted a targeted narrative review of peer-reviewed English-language literature identified through PubMed/MEDLINE, CINAHL, and reference chaining. We prioritized adult stroke systematic reviews, controlled studies, mechanistic investigations, and implementation research through June 2026. Seminal pre-2010 studies and evidence from other neurological populations were used only to explain mechanisms or gaps and are labeled as indirect. We did not undertake exhaustive retrieval, formal risk-of-bias assessment, or quantitative pooling.</p><p><strong>Results: </strong>Evidence is most consistent for rhythmic auditory stimulation for gait and selected music-supported upper-limb programs. Melodic intonation therapy may improve trained utterances and repetition in nonfluent aphasia, but transfer to everyday communication is uncertain. Listening and singing programs show potential for cognition, mood, engagement, and sleep, although protocols are heterogeneous. Post-stroke swallowing evidence is preliminary, and blood-brain barrier effects remain preclinical. Outcomes may vary with stroke phase, phenotype, cognition, hearing, comorbidity, musical reward and preference, dose, and provider expertise.</p><p><strong>Conclusions: </strong>Music-based rehabilitation comprises mechanism-informed adjuncts rather than one treatment. Clinical use should link a defined musical ingredient to a functional target, document provider and dose, incorporate preference and safety screening, and measure everyday transfer. Larger pragmatic and mechanism-specific trials with prespecified moderator analyses are needed.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"1-11"},"PeriodicalIF":2.3,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical dependence, self-efficacy, and resilience in stroke patients: a double-moderated mediation model of healthcare group and pre-stroke employment.","authors":"Hsiu-Ling Hsieh, Chia-Pang Shih, Wen-Yuan Lee, Ching-Hua Chu, Sung-Yuan Sung, Huey-Fen Wang","doi":"10.1080/10749357.2026.2723405","DOIUrl":"https://doi.org/10.1080/10749357.2026.2723405","url":null,"abstract":"<p><strong>Aims: </strong>To examine the concurrent relationships between physical dependence, self-efficacy, and resilience among stroke patients, and to explore whether the healthcare intervention group and pre-stroke employment status jointly moderate this mediated relationship.</p><p><strong>Design: </strong>A cross-sectional study using moderated mediation analysis.</p><p><strong>Methods: </strong>A total of 123 participants were recruited from a neurology ward in a hospital. Instruments included the Chinese version of the Resilience Scale, the Stroke Self-Efficacy Questionnaire, and the Modified Rankin Scale. Descriptive statistics, correlation analyses, and independent samples t-tests were performed. PROCESS macro (Model 21) with 5,000 bootstrap samples was applied to examine the hypothesized double-moderated mediation model.</p><p><strong>Results: </strong>Self-efficacy mediated the concurrent relationship between physical dependence and resilience. The healthcare intervention group moderated the relationship between physical dependence (operationalized as a binary threshold [mRS ≤ 3 vs. mRS = 4]) and self-efficacy, whereas pre-stroke employment status moderated the relationship between self-efficacy and resilience. Crucially, the conditional indirect pathway was statistically significant exclusively within the routine care group among patients who were unemployed prior to stroke onset.</p><p><strong>Conclusions: </strong>Greater physical dependence is concurrently associated with lower resilience, a concurrent relationship where lower self-efficacy serves as a partial mediator. This conditional indirect pathway is particularly pronounced among individuals who receive standard routine care and concurrently lack pre-stroke occupational engagement. For patients who were employed before stroke, the concurrent link between self-efficacy and resilience is absent, suggesting that their psychological adaptation is characterized by distinct environmental or vocational factors.</p><p><strong>Implications for practice and patient care: </strong>Routine assessment of physical dependence is crucial for evaluating current functional status and adjusting care plans accordingly. Incorporating social role context and employment history into rehabilitation strategies may further support psychosocial adaptation in stroke patients.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"1-15"},"PeriodicalIF":2.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}