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Essential Role of Social Context and Self-Efficacy in Daily Paretic Arm/Hand Use After Stroke: An Ecological Momentary Assessment Study With Accelerometry

  • Author Footnotes
    1 Current affiliation for Yi-An Chen is Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA.
    Yi-An Chen
    Correspondence
    Corresponding author Yi-An Chen, Urban Life Building, Suite 1242, 140 Decatur St, Atlanta, GA 30303.
    Footnotes
    1 Current affiliation for Yi-An Chen is Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA.
    Affiliations
    Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA
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  • Rebecca Lewthwaite
    Affiliations
    Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA

    Rancho Los Amigos National Rehabilitation Center, Downey, CA
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  • Nicolas Schweighofer
    Affiliations
    Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA
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  • John R. Monterosso
    Affiliations
    Department of Psychology, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA
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  • Beth E. Fisher
    Affiliations
    Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA

    Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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  • Carolee Winstein
    Affiliations
    Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA

    Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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  • Author Footnotes
    1 Current affiliation for Yi-An Chen is Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA.
Published:September 23, 2022DOI:https://doi.org/10.1016/j.apmr.2022.09.003

      Abstract

      Objective

      To determine the momentary effect of social-cognitive factors, in addition to motor capability, on post-stroke paretic arm/hand use in the natural environment.

      Design

      A 5-day observational study in which participants were sent 6 Ecological Momentary Assessment (EMA) prompts/day.

      Setting

      Participants’ daily environment.

      Participants

      Community-dwelling, chronic stroke survivors with right-dominant, mild-moderate upper extremity paresis (N=30).

      Interventions

      Not applicable.

      Main Outcome Measures

      Time duration of bimanual and unimanual paretic arm/hand use indexed by accelerometry; social-cognitive factors (social context, self-efficacy, mood) captured by EMA; motor capability of the paretic limb measured by Fugl-Meyer Upper Extremity Motor Assessment (FM).

      Results

      After accounting for participants’ motor capability, we found that momentary social context (alone or not) and self-efficacy significantly predicted post-stroke paretic arm/hand use behavior in the natural environment. When participants were not alone, paretic arm/hand movement increased both with and without the less-paretic limb (bimanual and unimanual movements, P=.018 and P<.001, respectively). Importantly, participants were more likely to use their paretic arm/hand (unimanually) if they had greater self-efficacy for limb use (P=.042). EMA repeated-measures provide a real-time approach that captures the natural dynamic ebb and flow of social-cognitive factors and their effect on daily arm/hand use. We also observed that people with greater motor impairments (FM<50.6) increase unimanual paretic arm/hand movements when they are not alone, regardless of motor capability.

      Conclusions

      In addition to motor capability, stroke survivors’ momentary social context and self-efficacy play a role in paretic arm/hand use behavior. Our findings suggest the development of personalized rehabilitative interventions which target these factors to promote daily paretic arm/hand use. This study highlights the benefits of EMA to provide real-time information to unravel the complexities of the biopsychosocial (ie, motor capability and social-cognitive factors) interface in post-stroke upper extremity recovery.

      Keywords

      List of abbreviations:

      CAHM (Confidence in Arm and Hand Movements Scale), EMA (Ecological Momentary Assessment), FM (Fugl-Meyer Upper Extremity Motor Assessment), HLM (hierarchical linear regression model), PANAS (positive and negative affect schedule), TimeB (bimanual arms/hands movement measured by the accelerometry), TimeR (unimanual paretic right arm/hand movement measured by the accelerometry)
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