Journal of Rehabilitation Medicine 51-1CompleteIssue

Temporal stability of psychological factors post-stroke These inconsistencies and limited findings in pa- tients with stroke show the need for further explora- tion of the temporal stability of psychological factors. Therefore, the main aim of the current study was to ex- plore whether psychological factors, namely proactive coping, self-efficacy, extraversion, optimism, passive coping, neuroticism and pessimism, are stable over the first 2 years post-stroke. Furthermore, we explored possible clustering of these psychological factors. METHODS Design and procedure The current study was part of the Restore4Stroke cohort study, a multicentre prospective longitudinal cohort study in which patients with stroke were recruited on admission to the acute stroke unit at 1 of 6 general hospitals in the Netherlands and were followed up for 2 years after their stroke. Details of the study procedures are given elsewhere (20). The medical ethics committees of all participating hospitals provided approval. Participants were recruited between March 2011 and March 2013 and all provided written informed consent. After obtaining participants’ informed consent, information on stroke-related factors (e.g. type of stroke, lateralization, stroke severity, activities of daily living (ADL) dependency) was ex- tracted from the hospital database. Information on demographic factors was obtained from the patient or family members (within the first week post-stroke). At 2 months post-stroke, participants completed self-report questionnaires regarding psychological factors and underwent cognitive screening with a trained re- search assistant. At 2 years post-stroke, participants completed the same self-report questionnaires regarding psychological factors. The questionnaires were administered on computer or paper and were guided by a research assistant if necessary. Participants Inclusion criteria of the Restore4Stroke cohort study were: ≥18 years old, having a diagnosis of stroke (ischaemic or intracere- bral haemorrhagic lesion) clinically confirmed by the treating neurologist and stroke onset within the last 7 days. Exclusion criteria were: (i) having a serious other condition that could be expected to influence the study outcomes (e.g. can- cer or dementia); (ii) having already been dependent regarding activities of daily living (ADL) before the stroke, as defined by a Barthel Index (BI) score ≤ 17; (iii) having insufficient com- mand of the Dutch language to understand and complete the questionnaires, based on clinical judgment; and (iv) experiencing cognitive decline before the stroke, as defined by a score ≥ 1 on the Heteroanamnesis List Cognition (HLC). The HLC is a 5-item questionnaire, completed by the patient’s spouse, assessing premorbid cognitive dysfunctioning on 5 cognitive domains. Participants who completed the questionnaires for psychological factors at 2 years post-stroke were selected for the current study. Measures Details and references for all measures are described elsewhere (20). Demographic and stroke-related factors. Data regarding age, sex, education and marital status (single or in a relationship) 19 were collected. The highest completed level of education was recorded according to the 7-point Verhage system, classifying the Dutch education system into 7 categories ranging from no primary school completed (“1”) to completion of a higher educational level (such as college (“6”) and university (“7”)). Stroke-related factors, such as type (ischaemic, haemorrhagic or unknown/other), lateralization (left, right, cerebellar, brainstem or unknown/other), severity (assessed by the National Institutes of Health Stroke Scale (NIHSS)) and discharge destination (home, or (geriatric) rehabilitation) were collected. ADL was measured with the Barthel Index at day 4 post-stroke and cog- nitive functioning was measured with the Montreal Cognitive Assessment (MoCA) at 2 months post-stroke. Psychological factors. All questionnaires to assess psycholo- gical factors are reliable and valid in patients with stroke (20). Proactive coping competencies were assessed with the Utrecht Proactive Coping Competence scale (UPCC). The 1-month test–retest reliability is 0.72 (21).The questionnaire consists of 21 items scored on 4-point scale ranging from “not very compe- tent” to “competent”. A mean score is calculated, ranging from 1 to 4, with a higher score indicating a higher level of proactive coping competencies. Self-efficacy was assessed with the General Self-Efficacy Scale (GSES). The 7-week test–retest reliability is 0.72 (22). The scale consists of 10 items scored on a 4-point scale ranging from “not at all true” to “exactly true”. A sum score is calculated, ranging from 10 to 40, with a higher score indicating a higher level of self-efficacy. Extraversion and neuroticism were assessed with 2 subscales of the Eysenck Personality Questionnaire Revised Short Scale (EPQ-SS). Both scales consist of 12 items with a dichotomous (yes/no) response option. The 6-month test–retest reliability is 0.85 for optimism and 0.70 for neuroticism (23). A sum score is calculated, ranging from 0 to 12, with a higher score indicating a higher level of extraversion or neuroticism, respectively. Optimism and pessimism were assessed with the Life Orienta- tion Test Revised (LOT-R). The 4-month test–retest reliability is 0.68 (24). It consists of 10 items, with 3 items measuring optimism, 3 items measuring pessimism and 4 filler items. The items are scored on a 5-point scale ranging from “strongly disagree” to “strongly agree”. A score is calculated per subscale, ranging from 0 to 12, with a higher score indicating a higher level of optimism or pessimism, respectively. Passive coping was assessed with the passive reaction pat- tern subscale of the Utrecht Coping List (UCL). The 6-week test–retest reliability is 0.84 for the passive reaction pattern subscale (25). The questionnaire consists of 7 items, scored on a 4-point scale ranging from “seldom” to “very often”. A sum score is calculated, ranging from 7 to 28, with a higher score indicating a higher level of passive coping. Statistical analyses Preparatory analyses. All data analyses were performed using SPSS Statistics 24.0 for Windows (IBM Corp., Armonk, NY, USA). Missing data were inspected and imputed with the mean value within the corresponding subscale if at least 80% of the participant’s data of the specific questionnaire was available. For the GSES, the criterion suggested by the manual of at least 70% non-missing data was used. Data were inspected for normality and outliers. In case of non-normality (skewness or kurtosis value <–1 or >+1), data were transformed. Skewness to the right was resolved with a logarithmic transformation. A quadratic transformation was executed to resolve skewness J Rehabil Med 51, 2019

Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 22