Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 25

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M. L. M. Wijenberg et al.
Table V. Factor loadings based on exploratory factor analysis after Oblimin rotation
Factor 1
“Maladaptive PF” b
Factor 2
”Adaptive PF”
Proactive coping
Two years post-stroke a
Two months post-stroke
Self-efficacy c
Extraversion
Optimism
–0.36
0.72
c
Passive coping
Neuroticism
Pessimism
Eigenvalues
Explained variance, %
Factor correlation
Factor 1
”Adaptive PF”
0.61
0.81 0.85
0.77
0.37
0.33 0.58
Factor 2
”Maladaptive PF”
–0.51
0.68
0.86
3.03
1.02
43.55
–0.58
0.97
0.35
0.86
3.76
54.84
–0.70
Factor loadings < 0.3 are suppressed.
a
Forced 2-factor analysis.
b
Factor correlation and loadings are inverted for interpretation purposes.
c
Based at 2 months post-stroke on transformed data due to non-normality.
PF: psychological factor.
psychological factor”, respectively. Passive coping and
neuroticism had positive loadings on the maladaptive
factor, whereas optimism had a negative loading on this
factor. Proactive coping, self-efficacy, extraversion and
optimism had positive loadings on the adaptive factor.
Pessimism did not load on any factor. The explained
variance of the 2 factors together was 43.6%.
At 2 years post-stroke, factors 1 and 2 are labelled
as “adaptive psychological factor” and “maladaptive
psychological factor”, respectively. Proactive coping,
self-efficacy and extraversion had positive loadings on
the adaptive factor. Passive coping, neuroticism and
pessimism had positive loadings on the maladaptive
factor. Furthermore, optimism had a negative loading
on this factor. The explained variance of the 2 factors
together was 54.8%.
DISCUSSION
This study found that scores on measures of psycho-
logical factors changed during the first 2 years post-
stroke. The psychological factors were moderately to
strongly correlated with each other and over time and
clustered at both time-points into 2 factors: an “adap-
tive psychological factor” (proactive coping, self-effi-
cacy, extraversion) and a “maladaptive psychological
factor” (passive coping and neuroticism). Scores on
all adaptive psychological factors decreased over time,
whereas scores on maladaptive psychological factors
increased or remained stable (passive coping) over
time. The added value of our study is that we evaluated
the temporal stability of multiple psychological factors
simultaneously in a large cohort of patients with stroke
using a longitudinal design.
To the best of our knowledge, the finding of a nega-
tive temporal impact across all psychological factors
post-stroke has not been demonstrated previously. As
mentioned in the introduction, previous research on
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temporal stability of psychological factors in stroke and
other populations showed inconsistent results across
and within psychological factors, possibly due to the
use of different measures, time-points and designs.
Strikingly, even though the sample consisted mainly
of patients with a mild stroke overall changes in a ne-
gative direction were found. In comparing our results
with previous findings regarding temporal stability
of psychological factors in healthy populations, we
found different patterns of changes over time. Most
studies assessing psychological factors in healthy
adults showed temporal stability (9–14), whereas our
data showed temporal changes in a negative direction
across all psychological factors. This suggests that the
occurrence of a stroke could be a possible cause of the
observed negative changes over time.
The occurrence of stroke results in negative changes
regarding emotional, cognitive and energy resources,
which could provide an explanation for the observed
negative change of psychological factors over time.
After a stroke, many patients suffer from depression
(30), cognitive complaints (31) and disabling fatigue
(32), increasing their burden and calling on their
reserves of resilience. The observed negative chan-
ges in psychological factors could be concomitant
with these negative emotional, cognitive and energy
changes. In fact, it was shown that neuroticism is
concomitant with depressive symptoms (33), and
that cognitive complaints in patients with traumatic
brain injury (TBI) are associated with the use of ma-
ladaptive coping styles (7). In our sample, 66% were
considered to be cognitively impaired (MoCA score
≤ 25) at 2 months post-stroke. Furthermore, Wu et
al. (32) proposed a biopsychosocial model including
psychological factors as an explanation for fatigue
after stroke. Taken together, stroke is associated with
negative changes in emotional, cognitive or energy
resources. These consequences of stroke may form