Grosse-Ophoff, L. (Laura) (2016) Analysis of the Correlation between Social Environment and Resilience in Stroke Patients and its Connection with Social Participation. thesis, Medicine.
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Abstract
Theoretical background: Stroke is a prevalent acute-onset cardiovascular event and one of the major leading causes of death in Germany. Even though the mortality rates are decreasing in developed countries, the morbidity and burden of disease associated with stroke remains high. Many patients face physical, psychological and social long-term consequences. It is interesting however, that some individuals tend to be better able to cope with such adversity. They are more likely to quickly return to normal levels of (mental) functioning than others, despite similar prognoses. This adaptation is called resilience. In resilience research, a shift has taken place from seeing resilience as a set inner psychological trait towards seeing it as a more active patient-environment concept. This allows for the search of risk and protective factors. Social environment is picked out of an array of proposed protective resources and analyzed in this study. A similar paradigm shift has taken place in rehabilitation medicine. The biomedical, diseasecentered approach of patient care has changed towards a health-centered bio-psychosocial model. In this light, participation in society and daily activities equally good to that before the event has become a major treatment goal of rehabilitation. As the International Classification of Functioning and Health (ICF) model sees limitations in participation and functional health as the sum of the health problems, personal and external factors, it seems interesting to analyze the connection between social environment and participation in stroke patients. Also, light should be shed on the connection between resilience and participation to see whether resilient individuals are better able to participate after stroke. Aim: In this exploratory study, the aim was to analyze the correlations between resilience, social environment and participation. Methods: This study is designed as a prospective cohort study. Sixty-four patients with the clinical diagnosis of ischaemic or haemorrhagic stroke were recruited at the stroke unit of the Evangelisches Krankenhaus Oldenburg in the acute phase 1-7 days post-event. Twenty-eight patients took part in the follow-up survey during their rehabilitation phase 1,5 to 3 months post-stroke. Patients answered a set of previously validated and reliable, German-language questionnaires. Data on the following variables were collected: resilience, limitations of participation, social environment (social support, partnership, frequency of social contacts), sociodemographic and medical variables. The Wilcoxon signed-rank test was used to compare the questionnaire outcomes of the two time points. Spearman-Rank correlations coefficients were calculated to determine the strength of connection between resilience and social environment factors, participation and social environment factors and resilience and participation. Simple linear regression was used in an exploratory attempt to find a directive connection between resilience and a calculated social environment sum score. An alpha value of 0,05 was predefined as the level of statistical significance. Results: The response rate at time point t1 was 64% at time point t2 54%. More men (58%) than women (42%) participated in the study. The average age was 65 years, with the women being on average older than the men. The great majority (96%) had minor to moderate stroke symptoms at admission. A significant change in questionnaire outcomes was detected only between resilience scores at the two time points (p=0,029), with resilience being higher at time point t2. No significant linear correlations were found between resilience and the social environment factors, though some correlations showed a medium effect. Regression analysis showed that 4,2-5,7% of variation in resilience could be explained by the social environment sum score. No significant linear correlations were found between participation and social environment factors except for a significant negative correlation between limitations in participation and a secure attachment style (p=0,004). Resilience and limitations in participation show a negative correlation, which is not significant. Conclusion: The majority of the findings are in line with current research and the formulated hypotheses. The effects detected however are small to medium and significance is lacking. Albeit showing trends, the results of the present study remain indeterminate. Through increasing the sample size in future studies, statistical power could be enlarged and possible missed subtle effects may become more apparent. The fact that resilience levels significantly change over time raises an objection against the theorem of resilience being a stable personality trait and emphasizes the presumption of more recent studies that resilience is in fact a dynamic process. This change should be verified further, using a greater sample size and testing across a greater period of time.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Kuks, Prof. Dr. J.B.M University of Groningen |
| Supervisor name: | Engelhardt, Prof. Dr. A. and Gertje, E.C.M.Sc. and Workgroup “Stroke and Resilience” and University Clinic Neurology, Evangelisches Krankenhaus Olden |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:41 |
| Last Modified: | 25 Jun 2020 10:41 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/270 |
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