Dynamics of Perceived Social Isolation, Secondary Conditions, and Daily Activity Patterns Among Individuals With Stroke: A Network Analysis of Ecological Momentary Assessment Data

Overview

Journal Arch Phys Med Rehabil

Specialty Rehabilitation Medicine

Date 2024 Mar 8

PMID 38458373

Authors

Yun Shi

Mandy W M Fong

Christopher L Metts

Sherri L LaVela

Charles Bombardier

Lu Hu

Alex W K Wong

Affiliations

Soon will be listed here.

Abstract

Objective: To assess contemporaneous and temporal dynamics of perceived social isolation (PSI), secondary conditions, and daily activity patterns in individuals post-stroke.

Design: Longitudinal observational study using ecological momentary assessment (EMA) as a real-time assessment of an individual's lived experiences. We conducted dynamic network analyses to examine longitudinal associations among EMA variables.

Settings: Home and Community.

Participants: 202 individuals with mild-to-moderate chronic stroke (median age=60 years; 45% women; 44% black; 90% ischemic stroke; median NIHSS score=2; N=202).

Intervention: Not applicable.

Main Outcome Measures: EMA questions measured PSI, secondary conditions (pain, tiredness, stress, anxiety, worthlessness, difficulty concentrating, and cheerfulness), and daily activity patterns (being at home, being alone, and participating in productive activities).

Results: The median EMA response rate was 84%. The contemporaneous model showed that PSI was associated with being home, alone, and all symptoms except pain. The temporal model revealed a pathway indicating that feelings of worthlessness predicted PSI (regression coefficient=0.06, P=.019), followed by stress (regression coefficient=0.06, P=.024), and then by being not at home (regression coefficient=-0.04, P=.013).

Conclusion: Implementing dynamic network analyses on EMA data can uncover dynamic connections among PSI, secondary conditions, and daily activity patterns after stroke. This study found a significant temporal association between PSI and negative emotions. Feeling isolated was followed by feeling stressed, which was followed by a tendency to be out of home, indicating adaptive behaviors in individuals with stroke. These findings highlight the importance of engaging in out-of-home or outdoor activities to mitigate PSI and negative emotions.

Citing Articles

Social isolation in the young and middle-aged patients with stroke: role of social support, family resilience and hope.

Wu X, Ke K, Liu H, Zhan S, Wang L, He J Front Psychiatry. 2025; 16:1499186.

PMID: 40012713 PMC: 11861369. DOI: 10.3389/fpsyt.2025.1499186.

Spiritual needs and influencing factors among people with stroke in China: a cross-sectional study.

Li Z, Cao X, Li S, Huang T, Liu Y, Qin L BMC Nurs. 2024; 23(1):507.

PMID: 39075439 PMC: 11287944. DOI: 10.1186/s12912-024-02182-7.

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