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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, Phone: 412-383-6620.
    Affiliations
    Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA

    Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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  • Lisa Tabor Connor
    Affiliations
    Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA

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

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

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

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

    Department of Education, Washington University School of Medicine, St. Louis, MO, USA
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  • Jin-Moo Lee
    Affiliations
    Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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  • Carolyn M. Baum
    Affiliations
    Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA

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

    Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
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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 seven days of ecological momentary assessment (EMA), during which participants completed eight EMA surveys per day. Multilevel modeling was used to analyze data.

      Setting

      Community.

      Participants

      Forty community-dwelling stroke survivors.

      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<0.001). Within-person autonomous motivation significantly buffered the momentary associations of physical fatigue (B=-0.06, p<0.001), mental fatigue (B=-0.04, p=0.032), and pain (B=-0.21, p<0.001) 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)
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