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

• Published in: Archives of physical medicine and rehabilitation Vol. 105; no. 7; pp. 1314 - 1321
• Main Authors: Shi, Yun, Fong, Mandy W.M., Metts, Christopher L., LaVela, Sherri L., Bombardier, Charles, Hu, Lu, Wong, Alex W.K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2024
• Subjects: Activities of Daily Living; Aged; Daily activities; Depression; Dynamic network; Ecological Momentary Assessment; Female; Humans; Loneliness; Longitudinal Studies; Male; Middle Aged; Mobile health; Rehabilitation; Social isolation; Social Isolation - psychology; Stress; Stress, Psychological - psychology; Stroke; Stroke - psychology; Stroke Rehabilitation - psychology; Stroke; PSI; Depression; Stress; Ecological momentary assessment; CBT; Social isolation; Mobile health; Loneliness; EMA; Dynamic network; Rehabilitation; Daily activities
• ISSN: 0003-9993; 1532-821X; 1532-821X
• DOI: 10.1016/j.apmr.2024.02.733

•Worthlessness predicted perceived social isolation contemporaneously and temporally.•Out-of-home activities alleviated perceived social isolation and negative emotions.•EMA and network analysis are valuable for studying social isolation dynamics. To assess contemporaneous and temporal dynamics of perceived social isolation (PSI), secondary conditions, and daily activity patterns in individuals post-stroke. 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. Home and Community. 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). Not applicable. 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). 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). 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.