Acceptance Of Disability And Its Influencing Factors Among Initial Stroke Patients:A Longitudinal Study

Objective To analyze the acceptance of disability and its influencing factors among initial stroke patients in hospital; To summarize trends in acceptance of disability for the first six months among initial stroke patients; To explore impact factors for longitudinal trends of acceptance of disability in the first 6 months among initial stroke patients.Methods Longitudinal design was used, and initial stroke patients in a specialized hospital in Tianjin were enrolled as participants from March to May, 2015. Patients were investigated at four time points: During hospitalization, 1st, 3rd and 6th month after discharge.The theoretical frame work of the questionnaire is the ICF interaction model,which included basic situation, Adaptation Of Disability Scale-Revised, Medical Coping Modes Questionnaire, Functional Activities Questionnaire, Self-Rating Depression Scale and Perceived Social Support Scale.Multiple linear regression analysis(SPSS 17.0) was employed to analyze influencing factors of acceptance of disability among initial stroke patients in hospital.Univariate repeated measures variance analysis was used to describe changes of acceptance of disability and related factors. Mixed linear model(SAS 9.3) was set up to explore impact factors of longitudinal trends in acceptance of disability.Results1. 150 participants were enrolled and 144 finally completed the follow-up study. 6cases were lost for various reasons, and dropout rate was 4%.2. Acceptance of disability for initial stroke patients during hospitalization was in moderate level(73.56±15.44), as the ranking demonstrated for each dimension:Enlargement is the highest, and subordination is the lowest.3. Multiple linear regression analysis showed that confrontation, the understanding of disease control, depression, functional activities, and perceived family support are major factors affecting acceptance of disability among initial stroke patients, which explained 52.5% of the total variance. Patients who got worse disabilityacceptance shared the following features: a lack of knowledge in disease control, a more serious depression level, worse functional activities, lower level of perceived family support and confrontation.4. The rising trends of acceptance of disability demonstrated an “urgent-slow” curve:Score at each time point was higher than the previous one(P<0.01). The trend experienced slower rise from 3rd month to 6th month after discharge. Score at 6th month after discharge was in high acceptance level.5. As mixed linear model showed, impact factors of longitudinal trends in acceptance of disability included rehabilitation type, payment method for medical expense,functional activities, depression and confrontation level. The rising trend is more obvious for patients with home-based rehabilitation, medical insurance, a better status of functional activities, depression and confrontation level. The remaining patients(hospital rehabilitation, at their own expense, a worse status of functional activities, depression and confrontation level) may experience a more difficult process of acceptance.Conlusions This study has revealed longitudinal trends of acceptance of disability and its influencing factors in the first 6 months among initial stroke patients. The research stressed the importance of assessing psychological changes in disability acceptance.Nurses should detect initial stroke patients who are in low level of disability acceptance. Oriented by every dimension and influencing factors, proper psychological interventions should be provided to enhance the level of disability acceptance and psychosomatic rehabilitation. This research has provided theoretical evidence for further research, as long as stroke rehabilitation in hospital and after discharge.