| Objectives(1)To systematically search and review the literature on post-traumatic growth and related factors of stroke patients at home and abroad,summarize the current studies status,and provide evidence-based support for the project.(2)Longitudinal survey of young and middle-aged stroke patients from stable acute hospitalization to 6 months after discharge at three different time points of post-traumatic growth,growth mixed model will be used to fit the type and characteristics of the trajectory of posttraumatic growth.(3)To analyze the influencing factors of different types of post-traumatic growth trajectory in young and middle-aged stroke patients,and to explore the predictive indicators of different periods of post-traumatic growth trajectory in young and middle-aged stroke patients.Methods This research consists of two parts.Part Ⅰ : Systematic review of post-traumatic growth and influencing factors in patients with stroke.The related literatures about post-traumatic growth of stroke patients from the date of database establishment to December 31,2019 were searched by the combination of subject words and free words.The domestic databases included:Chinese Journal Full-text Database(CNKI),Wanfang Data knowledge service platform,VIP database,Sino Med database and Baidu academic database.Foreign databases include: Cochrane Library,JBI evidence-based nursing center library,web of science,Pub Med,EMBASE,CINAHL.The quality evaluation criteria for observational studies by the American agency for healthcare research and quality(AHRQ)were adopted.The final included literatures were summarized and described by qualitative analysis.Part Ⅱ : Longitudinal Trajectory and Predicted Factors of Posttraumatic Growth in Middle and Young Stroke Patients.(1)Using longitudinal follow-up survey method,taking the results of simplified Chinese version of posttraumatic growth assessment questionnaire as the main index,the young and middle-aged stroke patients were assessed at different stages: stable hospitalization(T0),1 month after discharge(T1),3 months after discharge(T2)and6 months after discharge(T3).Firstly,repeated measurement ANOVA was used to analyze the overall trend of posttraumatic growth,and then the results were compared The growth mixed model was used to fit the potential categories of posttraumatic growth trajectory.The best fitting model was determined according to the log likelihood,information index,entropy,BLRT and VLMR test results.(2)To investigate the demographic and sociological data,disease-related data,cognitive processing variables and psychosocial indicators of young and middle-aged stroke patients,and to analyze the predictors of their posttraumatic growth trajectory.First,the independent variables with statistical significance were screened by univariate analysis,and then the predictive factors of different trajectories of posttraumatic growth in young and middle-aged stroke patients were explored by multivariate logistic regression analysis.Results Part Ⅰ : Systematic review of post-traumatic growth and influencing factors in patients with stroke.A total of 18 literatures related to post-traumatic growth of stroke patients were included,of which one was longitudinal study and the rest were cross-sectional studies.One of the mixed studies selected part of the quantitative research data,and the research method was mainly quantitative investigation.Post-traumatic growth is common in stroke patients,but the level of posttraumatic growth is medium or low.The highest score is(65.39±2.15)and the lowest score is(37.78±12.89).According to the description model of post-traumatic growth function,combined with sufficient literature review,the related factors affecting posttraumatic growth could be divided into three parts: individual internal factors(mainly referring to patients’ social demography,disease information,psychological status,etc.),individual external factors(such as social support,family support,coping strategies,etc.).Part Ⅱ : Longitudinal Trajectory and Predicted Factors of Posttraumatic Growth in Middle and Young Stroke Patients.(1)The mean scores of post-traumatic growth of young and middle-aged stroke patients at four time points were(53.37±16.25),(50.11±18.10),(46.13±20.73)and(42.48±23.44)respectively.In the acute hospitalization period,it was below the medium level,and then gradually decreased with time.Through the analysis of the growth mixed model,the three potential categories were determined to have the best data fitting results,and the sample number of each category was more appropriate,and the BLRT and VLMR tests were statistically significant.The proportion of patients with three kinds of trajectories of posttraumatic growth were named as high level stable growth group,moderate level growth group and continuous decline growth group,which accounted for 33.51%,24.61% and 41.89% respectively.(2)After univariate analysis,the independent variables with statistical significance were as follows: family per capita monthly income,personality type,the number of dysfunction from T0 to T3.The total score of social support and each dimension score at T0;positive and negative coping styles at T0.Invasive rumination and purposive rumination scores at T0 to T3.Anxiety and depression at T0 to T3 score.The results of multivariate logistic regression analysis have found that compared with the high-level stable growth group,the indicators that can predict the development of patients into the continuous decline growth group include introverted personality,family per capita income less than 1000 yuan,deliberate rumination at T0,invasive rumination at T3,and anxiety and depression at T3.Thirdly,compared with the continuous decline growth group,the factors of patients with continuous decline growth type developing into high-level growth stable group are positive coping style,deliberate rumination at T1 and T3.The predictive factors of moderate growth stable group include: total score of rumination at T1,deliberate rumination at T1 and T3.Conclusions(1)Through the systematic review of the level of post-traumatic growth and related factors of stroke patients at home and abroad,it is found that there is a certain degree of post-traumatic growth of stroke patients,which is affected by individual internal and external factors,but there is a lack of longitudinal tracking research on the changes and development of post-traumatic growth of stroke patients.(2)Based on the growth mixed model,it found that the trajectories of post-traumatic growth of young and middle-aged stroke patients in different stages within 6 months after discharge.There were three distinct types: high level stable growth group,moderate level growth group and continuous decline growth group.Most survivors had a certain level of posttraumatic growth in the early stage,but showed a gradual decline in the late development trend.(3)Through univariate analysis and multivariate logistic regression analysis,it was confirmed that the predictive factors of different post-traumatic growth trajectories of young and middle-aged stroke patients,including family economic status,personality type,number of dysfunction,ruminative meditation,anxiety and depression.All above had an impact on the trajectories of post-traumatic growth,which provided a reference for the prediction of post-traumatic growth trajectories of stroke patients in the future.It provided a reference and empirical support for the growth,change and development. |
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