Advertisement
ORIGINAL RESEARCH|Articles in Press

The Moderating Role of Motivation in the Real-Time Associations of Fatigue, Cognitive Complaints, and Pain With Depressed Mood Among Stroke Survivors: An Ecological Momentary Assessment Study

  • Stephen C.L. Lau
    Correspondence
    Corresponding author Stephen C.L. Lau, PhD, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, 100 Technology Drive, Suite 350, Pittsburgh, PA 15219, USA.
    Affiliations
    Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO

    Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
    Search for articles by this author
  • Lisa Tabor Connor
    Affiliations
    Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO

    Department of Neurology, Washington University School of Medicine, St. Louis, MO
    Search for articles by this author
  • Elizabeth R. Skidmore
    Affiliations
    Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
    Search for articles by this author
  • Allison A. King
    Affiliations
    Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO

    Department of Medicine, Washington University School of Medicine, St. Louis, MO

    Department of Pediatrics, Washington University School of Medicine, St. Louis, MO

    Department of Surgery, Washington University School of Medicine, St. Louis, MO

    Department of Education, Washington University School of Medicine, St. Louis, MO
    Search for articles by this author
  • Jin-Moo Lee
    Affiliations
    Department of Neurology, Washington University School of Medicine, St. Louis, MO
    Search for articles by this author
  • Carolyn M. Baum
    Affiliations
    Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO

    Department of Neurology, Washington University School of Medicine, St. Louis, MO

    Brown School of Social Work, Washington University in St. Louis, St. Louis, MO
    Search for articles by this author
Published:December 16, 2022DOI:https://doi.org/10.1016/j.apmr.2022.11.012

      Abstract

      Objective

      Stroke symptoms fluctuate during the day as stroke survivors participate in daily activities. Understanding the real-time associations among stroke symptoms and depressed mood, as well as the role of motivation for daily activities, informs, and post-stroke symptom management in the context of everyday living. This study aimed to (1) investigate the real-time associations of fatigue, cognitive complaints, and pain with depressed mood and (2) examine the role of motivation for daily activity participation as a potential moderator of these associations in stroke survivors.

      Design

      A prospective cohort study involving 7 days of ecological momentary assessment (EMA), during which participants completed 8 EMA surveys per day. Multilevel modeling was used to analyze data.

      Setting

      Community.

      Participants

      Forty community-dwelling stroke survivors (N=40).

      Interventions

      Not applicable.

      Main Outcome Measures

      EMA measures of depressed mood, stroke symptoms (physical and mental fatigue, cognitive complaints, and pain), and motivation (autonomous motivation, controlled motivation).

      Results

      Higher levels of within- and between-person physical fatigue, mental fatigue, cognitive complaints, and pain were momentarily associated with greater depressed mood (Ps<.001). Within-person autonomous motivation significantly buffered the momentary associations of physical fatigue (B=-0.06, P<.001), mental fatigue (B=-0.04, P=.032), and pain (B=-0.21, P<.001) with depressed mood.

      Conclusions

      Findings indicate the momentary associations of fatigue, cognitive complaints, and pain with depressed mood in stroke survivors. Autonomous motivation underpinning daily activity participation was found to buffer the associations of fatigue and pain with depressed mood. Promoting autonomous motivation for daily activity participation may be viable for preventing and mitigating poststroke depression.

      Keywords

      List of abbreviations:

      EMA (ecological momentary assessment), MLM (multilevel modeling), SDT (self-determination theory)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Towfighi A
        • Ovbiagele B
        • El Husseini N
        • et al.
        Poststroke depression: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2017; 48: e30-e43
        • Wulsin L
        • Alwell K
        • Moomaw CJ
        • et al.
        Comparison of two depression measures for predicting stroke outcomes.
        J Psychosom Res. 2012; 72: 175-179
        • Pan JH
        • Song XY
        • Lee SY
        • Kwok T.
        Longitudinal analysis of quality of life for stroke survivors using latent curve models.
        Stroke. 2008; 39: 2795-2802
        • Bartoli F
        • Lillia N
        • Lax A
        • et al.
        Depression after stroke and risk of mortality: a systematic review and meta-analysis.
        Stroke Res Treat. 2013; 2013862978
        • Naess H
        • Lunde L
        • Brogger J
        Waje-Andreassen U. Fatigue among stroke patients on long-term follow-up. The Bergen Stroke Study.
        J Neurol Sci. 2012; 312: 138-141
        • Şahin-Onat Ş
        • Ünsal-Delialioğlu S
        • Kulaklı F
        • Özel S.
        The effects of central post-stroke pain on quality of life and depression in patients with stroke.
        J Phys Ther Sci. 2016; 28: 96-101
        • Murata Y
        • Kimura M
        • Robinson RG.
        Does cognitive impairment cause post-stroke depression?.
        Am J Geriatr Psychiatry. 2000; 8: 310-317
        • Cumming TB
        • Packer M
        • Kramer SF
        • English C.
        The prevalence of fatigue after stroke: a systematic review and meta-analysis.
        Int J Stroke. 2016; 11: 968-977
        • Paciaroni M
        • Acciarresi M.
        Poststroke fatigue.
        Stroke. 2019; 50: 1927-1933
        • Young CA
        • Mills RJ
        • Gibbons C
        • Thornton EW.
        Poststroke fatigue: the patient perspective.
        Top Stroke Rehabil. 2013; 20: 478-484
        • Acciarresi M
        • Bogousslavsky J
        • Paciaroni M.
        Post-stroke fatigue: epidemiology, clinical characteristics and treatment.
        Eur Neurol. 2014; 72: 255-261
        • Jönsson AC
        • Lindgren I
        • Hallström B
        • Norrving B
        • Lindgren A.
        Prevalence and intensity of pain after stroke: a population based study focusing on patients' perspectives.
        J Neurol Neurosurg Psychiatry. 2006; 77: 590-595
        • Klit H
        • Finnerup NB
        • Overvad K
        • Andersen G
        • Jensen TS.
        Pain following stroke: a population-based follow-up study.
        PLoS One. 2011; 6: e27607
        • Widar M
        • Ek AC
        • Ahlström G.
        Coping with long-term pain after a stroke.
        J Pain Symptom Manage. 2004; 27: 215-225
        • Lindgren I
        • Gard G
        • Brogårdh C.
        Shoulder pain after stroke—experiences, consequences in daily life and effects of interventions: a qualitative study.
        Disabil Rehabil. 2018; 40: 1176-1182
        • Lo JW
        • Crawford JD
        • Desmond DW
        • et al.
        Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups.
        Neurology. 2019; 93: e2257-e2271
        • Nys GM
        • van Zandvoort MJ
        • van der Worp HB
        • et al.
        Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke.
        J Neurol Sci. 2006; 247: 149-156
        • Holley SR
        • Ewing ST
        • Stiver JT
        • Bloch L.
        The relationship between emotion regulation, executive functioning, and aggressive behaviors.
        J Interpers Violence. 2017; 32: 1692-1707
        • Forster SD
        • Gauggel S
        • Petershofer A
        • Völzke V
        • Mainz V.
        Ecological momentary assessment in patients with an acquired brain injury: a pilot study on compliance and fluctuations.
        Front Neurol. 2020; 11: 115
        • Lenaert B
        • Neijmeijer M
        • van Kampen N
        • van Heugten C
        • Ponds R.
        Poststroke fatigue and daily activity patterns during outpatient rehabilitation: an experience sampling method study.
        Arch Phys Med Rehabil. 2020; 101: 1001-1008
        • Gamaldo AA
        • Allaire JC.
        Daily fluctuations in everyday cognition: is it meaningful?.
        J Aging Health. 2016; 28: 834-849
        • Schneider S
        • Junghaenel DU
        • Keefe FJ
        • Schwartz JE
        • Stone AA
        • Broderick JE.
        Individual differences in the day-to-day variability of pain, fatigue, and well-being in patients with rheumatic disease: associations with psychological variables.
        Pain. 2012; 153: 813-822
        • Fougeyrollas P
        • Noreau L
        • Bergeron H
        • Cloutier R
        • Dion SA
        • St-Michel G.
        Social consequences of long term impairments and disabilities: conceptual approach and assessment of handicap.
        Int J Rehabil Res. 1998; 21: 127-141
        • Perenboom RJ
        • Chorus AM.
        Measuring participation according to the International Classification of Functioning, Disability and Health (ICF).
        Disabil Rehabil. 2003; 25: 577-587
        • Law M.
        Participation in the occupations of everyday life.
        Am J Occup Ther. 2002; 56: 640-649
        • Deci EL
        • Ryan RM.
        The general causality orientations scale: self-determination in personality.
        J Res Pers. 1985; 19: 109-134
        • Zhao G
        • Xie F
        • Luo Y
        • et al.
        Effects of self-control on subjective well-being: examining the moderating role of trait and state motivation.
        Front Psychol. 2021; 12774148
        • Trépanier S-G
        • Fernet C
        • Austin S.
        The moderating role of autonomous motivation in the job demands-strain relation: a two sample study.
        Motiv Emot. 2013; 37: 93-105
        • Fernet C
        • Gagné M
        • Austin S.
        When does quality of relationships with coworkers predict burnout over time? The moderating role of work motivation.
        J Organ Behav. 2010; 31: 1163-1180
        • Brott T
        • Adams HP
        • Jr Olinger CP
        • et al.
        Measurements of acute cerebral infarction: a clinical examination scale.
        Stroke. 1989; 20: 864-870
        • van Swieten JC
        • Koudstaal PJ
        • Visser MC
        • Schouten HJ
        • van Gijn J.
        Interobserver agreement for the assessment of handicap in stroke patients.
        Stroke. 1988; 19: 604-607
        • Foley EL
        • Nicholas ML
        • Baum CM
        • Connor LT.
        influence of environmental factors on social participation post-stroke.
        Behav Neurol. 2019; 20192606039
        • Vanbellingen T
        • Kersten B
        • Van de Winckel A
        • et al.
        A new bedside test of gestures in stroke: the apraxia screen of TULIA (AST).
        J Neurol Neurosurg Psychiatry. 2011; 82: 389-392
        • Friedman PJ.
        The Star Cancellation Test in acute stroke.
        Clin Rehabil. 1992; 6: 23-30
        • Bailey IL
        • Lovie JE.
        New design principles for visual acuity letter charts.
        Am J Optom Physiol Opt. 1976; 53: 740-745
        • Schow RL
        • Nerbonne MA.
        Communication screening profile: use with elderly clients.
        Ear Hear. 1982; 3: 135-147
        • Moskowitz DS
        • Young SN.
        Ecological momentary assessment: what it is and why it is a method of the future in clinical psychopharmacology.
        J Psychiatry Neurosci. 2006; 31: 13-20
        • Shiffman S
        • Stone AA
        • Hufford MR.
        Ecological momentary assessment.
        Annu Rev Clin Psychol. 2008; 4: 1-32
        • Jessup G
        • Bian S
        • Chen Y
        • Bundy A.
        Manual of PIEL survey application.[iPhone/iPod Touch/iPad/iPad mini application].
        The University of Sydney, Sydney, Australia2012
        • Chapman JJ
        • Fraser SJ
        • Brown WJ
        • Burton NW.
        The feasibility and acceptability of questionnaires and accelerometry for measuring physical activity and sedentary behaviour in adults with mental illness.
        J Ment Health. 2015; 24: 299-304
        • Pruitt LA
        • Glynn NW
        • King AC
        • et al.
        Use of accelerometry to measure physical activity in older adults at risk for mobility disability.
        J Aging Phys Act. 2008; 16: 416-434
        • Giné-Garriga M
        • Sansano-Nadal O
        • Tully MA
        • et al.
        accelerometer-measured sedentary and physical activity time and their correlates in European older adults: the SITLESS study.
        J Gerontol A Biol Sci Med Sci. 2020; 75: 1754-1762
        • Dunton GF
        • Leventhal AM
        • Rothman AJ
        • Intille SS.
        Affective response during physical activity: within-subject differences across phases of behavior change.
        Health Psychol. 2018; 37: 915-923
        • Moore RC
        • Kaufmann CN
        • Rooney AS
        • et al.
        feasibility and acceptability of ecological momentary assessment of daily functioning among older adults with HIV.
        Am J Geriatr Psychiatry. 2017; 25: 829-840
        • Lau S
        • Macpherson V
        • Lenze E
        • et al.
        Feasibility and validity of ecological momentary assessment of daily function in people after stroke.
        Arch Phys Med Rehabil. 2019; 100: e179
        • Baum CM
        • Edwards DF.
        Activity Card Sort (ACS).
        Washington University School of Medicine, St. Louis1995
        • Kanning M
        • Hansen S.
        Need satisfaction moderates the association between physical activity and affective states in adults aged 50+: an activity-triggered ambulatory assessment.
        Ann Behav Med. 2017; 51: 18-29
        • Gunnell KE
        • Crocker PRE
        • Mack DE
        • Wilson PM
        • Zumbo BD.
        Goal contents, motivation, psychological need satisfaction, well-being and physical activity: a test of self-determination theory over 6 months.
        Psychol Sport Exerc. 2014; 15: 19-29
        • Kroenke K
        • Spitzer RL
        • Williams JB.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Michielsen HJ
        • De Vries J
        • Van Heck GL.
        Psychometric qualities of a brief self-rated fatigue measure: the Fatigue Assessment Scale.
        J Psychosom Res. 2003; 54: 345-352
        • Mead G
        • Lynch J
        • Greig C
        • Young A
        • Lewis S
        • Sharpe M.
        Evaluation of fatigue scales in stroke patients.
        Stroke. 2007; 38: 2090-2095
        • Cella D
        • Lai JS
        • Nowinski CJ
        • et al.
        Neuro-QOL: brief measures of health-related quality of life for clinical research in neurology.
        Neurology. 2012; 78: 1860-1867
        • Gershon RC
        • Lai JS
        • Bode R
        • et al.
        Neuro-QOL: quality of life item banks for adults with neurological disorders: item development and calibrations based upon clinical and general population testing.
        Qual Life Res. 2012; 21: 475-486
        • Curran PJ
        • Bauer DJ.
        The disaggregation of within-person and between-person effects in longitudinal models of change.
        Annu Rev Psychol. 2011; 62: 583-619
        • Lo JW
        • Crawford JD
        • Desmond DW
        • et al.
        Long-term cognitive decline after stroke: an individual participant data meta-analysis.
        Stroke. 2022; 53: 1318-1327
        • Hinkle JL
        • Becker KJ
        • Kim JS
        • et al.
        Poststroke fatigue: emerging evidence and approaches to management: a scientific statement for healthcare professionals from the American Heart Association.
        Stroke. 2017; 48: e159-e170
        • Payton H
        • Soundy A.
        The experience of post-stroke pain and the impact on quality of life: an integrative review.
        Behav Sci. 2020; 10: 128
        • Terroni L
        • Sobreiro MFM
        • Conforto AB
        • et al.
        Association among depression, cognitive impairment and executive dysfunction after stroke.
        Dement Neuropsychol. 2012; 6: 152-157
        • Nahum-Shani I
        • Smith SN
        • Spring BJ
        • et al.
        Just-in-time adaptive interventions (JITAIs) in mobile health: key components and design principles for ongoing health behavior support.
        Ann Behav Med. 2018; 52: 446-462
        • Ryan RM
        • Deci EL.
        Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being.
        Am Psychol. 2000; 55: 68-78
        • Deci EL
        • Ryan RM.
        Facilitating optimal motivation and psychological well-being across life's domains.
        Can Psychol. 2008; 49: 14
        • Fernet C
        • Austin S
        • Vallerand RJ.
        The effects of work motivation on employee exhaustion and commitment: an extension of the JD-R model.
        Work Stress. 2012; 26: 213-229
        • Sheehan RB
        • Herring MP
        • Campbell MJ.
        Associations between motivation and mental health in sport: a test of the hierarchical model of intrinsic and extrinsic motivation.
        Front Psychol. 2018; 9: 707
        • Deary IJ
        • Corley J
        • Gow AJ
        • et al.
        Age-associated cognitive decline.
        Br Med Bull. 2009; 92: 135-152
        • Deci EL
        • Ryan RM.
        The “what” and “why” of goal pursuits: human needs and the self-determination of behavior.
        Psychol Inq. 2000; 11: 227-268
        • Friederichs SAH
        • Oenema A
        • Bolman C
        • Guyaux J
        • van Keulen HM
        • Move Lechner L.I
        systematic development of a web-based computer tailored physical activity intervention, based on motivational interviewing and self-determination theory.
        BMC Public Health. 2014; 14: 212
        • Miller WR
        • Rollnick S.
        Motivational interviewing: helping people change.
        3rd ed. Guilford Press, New York, NY2013
        • Miller WR
        • Rollnick S.
        Meeting in the middle: motivational interviewing and self-determination theory.
        Int J Behav Nutr Phys Act. 2012; 9: 25
        • Van Hoecke AS
        • Delecluse C
        • Opdenacker J
        • Lipkens L
        • Martien S
        • Boen F.
        Long-term effectiveness and mediators of a need-supportive physical activity coaching among Flemish sedentary employees.
        Health Promot Int. 2013; 28: 407-417
        • Friederichs SA
        • Oenema A
        • Bolman C
        • Lechner L.
        Long term effects of self-determination theory and motivational interviewing in a web-based physical activity intervention: randomized controlled trial.
        Int J Behav Nutr Phys Act. 2015; 12: 101
        • Sliwinski MJ
        • Mogle JA
        • Hyun J
        • Munoz E
        • Smyth JM
        • Lipton RB.
        Reliability and validity of ambulatory cognitive assessments.
        Assessment. 2018; 25: 14-30
        • Kok G
        • Bockting C
        • Burger H
        • Smit F
        • Riper H.
        Mobile cognitive therapy: adherence and acceptability of an online intervention in remitted recurrently depressed patients.
        Internet Interv. 2014; 1: 65-73
        • Wolf TJ
        • Baum CM
        • Lee D
        • Hammel J.
        The development of the Improving Participation after Stroke Self-Management Program (IPASS): an exploratory randomized clinical study.
        Top Stroke Rehabil. 2016; 23: 284-292
        • Schuling J
        • De Haan R
        • Mt Limburg
        • Groenier K.
        The Frenchay Activities Index. Assessment of functional status in stroke patients.
        Stroke. 1993; 24: 1173-1177
        • Apte A
        • Kielhofner G
        • Paul-Ward A
        • Braveman B.
        Therapists' and clients' perceptions of the Occupational Performance History Interview.
        Occup Ther Health Care. 2005; 19: 173-192