Perceptions of function and recovery among persons with stroke and care partners

Abstract

Purpose/objective: Perceptions of function can differ between persons with stroke and care partners. The current study described the frequency of discrepancy in ratings of poststroke functioning across romantic partners and examined associations between perceptions of function, depressive symptoms, and caregiver strain.

Research method/design: A secondary analysis was conducted using data from the baseline visit of an intervention pilot study. Twenty-nine dyads completed measures of perceived current functioning of the person with stroke (Stroke Impact Scale 3.0: overall percent recovery, ADL, and cognition), self-reported ratings of depressive symptoms for both partners (PROMIS Depression Short Form v8b), and self-reported caregiver strain for the care partners only (Caregiver Strain Index).

Results: A discrepancy of over 10 points on the SIS 3.0 variables was seen in over 50% of dyads for all subscales, with care partners rating worse recovery on average. Actor partner interdependence models showed that more depressive symptoms were associated with perceptions of worse overall recovery and ADL function in persons with stroke, whereas more depressive symptoms were associated with perceptions of worse cognitive and ADL function in care partners. Discrepancy in perception of ADL function was associated with more caregiver strain though this was inextricable from the overall level of impairment in ADL function perceived by the care partner.

Conclusions/implications: These findings suggest that discrepancy in perceptions of stroke recovery among romantic partners is common. This underscores the importance of perception when considering risk for depression and caregiver strain as well as how to best promote psychological resilience following stroke. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT03335358.

Figure 1.

This figure illustrates the magnitude of discrepancy on the SIS 3.0 for “visible” vs. “invisible” subscales. The magnitude of this difference did not reach statistical significance [t (28) = 1.403, p =.172]; SIS 3.0 Subscales = Stroke Impact Scale ratings of the person with stroke’s overall percent recovery or level of current function within a subscale. Scores reported were completed by both the person with stroke and their care partner. SIS 3.0 Discrepancy Scores were calculated as Care partner rating (of person with stroke’s functioning) – person with stroke’s ratings of their own function. For these ratings, negative discrepancy scores indicate that care partners rated the person with stroke as functioning worse than the person with stroke rated themselves, zero sum discrepancy scores indicated perfect agreement, and positive discrepancy scores indicated that the person with stroke rated themselves as having worse functioning than their care partner rated them as having.

Figure 2.

This figure shows the three APIM models showing the dyadic associations between depressive symptoms and perceptions of function and recovery. N = 58 persons (29 dyads); % = Percentage; * = statistically significant difference at p <.05 level; PROMIS Depression Scale = T scores of the individual’s self-report of their own current depressive symptoms; SIS 3.0 = Stroke Impact Scale ratings of the person with stroke’s overall percent recovery or level of current function within a subscale. Scores reported were completed by both the person with stroke and their care partner. Higher scores indicate more depressive symptoms, more stroke recovery and better function after stroke.