| Summary: | 博士 === 臺北醫學大學 === 護理學研究所 === 102 === Stroke survivors can experience a decline in physical and mental function. Regarding physical problems, stroke patients have demonstrated a variety of functional recovery trends and inconsistent recovery times ranging from several weeks to 1 year; however, few studies have explored individual differences in functional recovery. Regarding mental problems, stroke patients experience various forms of psychological distress, but researchers have not used an appropriate instrument to evaluate psychological distress. Furthermore, few studies have explored the effects of the various forms of psychological distress on the prognostic outcomes of stroke patients. Therefore, this study had 3 purposes: (1) to explore the trajectory groups and determinants of functional recovery for ischemic stroke patients 1 year after stroke; (2) to develop and validate a modified Chinese version of the Emotional and Social Dysfunction Questionnaire (ESDQ_C) for evaluating stroke patients; and (3) to describe the complexity and trajectory of psychological distress among stroke survivors, as well as explore the relationship between psychological distress and functional recovery. Results in the first study found that five trajectory clusters of functional recovery were identified. Nearly 18% of stroke patients（cluster 1 and 2）maintained functional dependence, whereas 82% of stroke patients （cluster 3, 4 and 5）demonstrated functional recovery, requiring 3 months of recovery. Determinants for various trajectory clusters of functional recovery were age, duration of disease, symptoms classification, body mass index and serum albumin level. A higher concentration of serum albumin generally predicted a more favorable functional recovery. In the second study, the results of confirmatory factor analysis confirmed that the ESDQ_C, based on a 6-factor model, exhibited satisfactory construct validity, and appropriately represented the emotional and social distress including anger, emotional dyscontrol, helplessness, inertia, indifference, and euphoria. Satisfactory validities including concurrent validity and known-group validity were also evident. Cronbach’s α coefficient for the total scale and subscales of ESDQ_C were 0.96 and 0.79-0.91, respectively. In the third study, results included: 1. Stroke patients experienced various forms of psychological distress, and that psychological distress significantly increased between time of admission and 2 months after discharge. 2. The various forms of psychological distress significantly mediated the effect of severe stroke syndromes on functional dependence. 3. The various forms of psychological distress exert a short-term, dynamic effect on functional recovery. The trajectory of various forms of psychological distress exerted significant negative effects on functional recovery. Our study confirmed that the ESDQ_C questionnaire is reliable, valid, and effective for assessing various types of emotional and social distress among Chinese stroke patients. Moreover differential trajectory of functional recovery persisted in stroke patient and various forms of psychological distress significantly inhibited functional recovery. By understanding the nature and effect of various forms of psychological distress, healthcare professionals can appropriate evaluate and design effective interventions to help improve mental and physical function in stroke patients.
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