| ObjectiveStroke is the second leading cause of death and the third leading cause of disability around the world,and the third leading cause of death in China.China is the country with the highest lifetime risk of stroke and the heaviest disease burden in the world.Stroke can cause many comorbidities,such as limb dysfunction,cognitive impairment,and emotional problems.The comorbidities seriously affect the quality of life of patients,increase the mortality,disability,and recurrence rates of stroke,and shorten the survival time.Perceived control is a subjective perception,feeling,or belief about control,which is the direct feeling of the individual believing that the outcome of an event is determined by actions.Previous studies in healthy elderly people and patients with chronic diseases such as asthma have shown that perceived control is positively correlated with cognitive function,emotion,quality of life,and health outcomes.Existing studies on perceived control among stroke patients are all cross-sectional studies,and few studies have reported the relationship between perceived control and cognitive function in stroke patients.The purpose of this study was to investigate the level and trend of perceived control of patients with acute ischemic stroke in China at different periods(acute phase,3 months of onset,and 6 months of onset),and the effect of perceived control on cognitive function,emotion,quality of life,and activities of daily living to provide evidence for functional rehabilitation and health management of stroke patients.MethodsA longitudinal study was conducted.From July 2020 to June 2021,convenient sampling was used in department of Neurology and Cerebrovascular Disease Center in three grade III,Grade A hospitals in Shanghai,Nanjing,and Linyi.245 patients with acute ischemic stroke from 3 stroke centers of tertiary first-class hospitals were recruited using convenient sampling.The first survey was conducted during the acute phase of hospitalization(T0).Follow-up investigations were conducted at two times: 3 months after onset(T1)and 6 months after onset(T2).Self-made general situation questionnaire(including name,age,date of birth,ethnic group,native place,job,education level/number of years,marital status,household registration type,home address,contact information),Disease-related information questionnaire(including height,weight,smoking and drinking history,history of chronic disease,family history of ischemic stroke,first stroke or not,OCSP classification,TOAST classification,time from onset to hospital,blood indicators,electrocardiogram,condition of large vessel stenosis,treatment methods,length of hospitalization,NIHSS score at admission and discharge),In T0,T1,and T2 periods,perceived Control in Health Care Questionnaire(PCHCQ)was usd to measure the level of perceived control,Montreal Cognitive Assessment Changsha Version(Mo CA-CS)was used to measure the cognitive function,the Short Version of the Stroke Specific Quality of Life Scale(SV-SS-Qo L)was used to measure the quality of life,the Center for Epidemiological Studies Depression Scale(CES-D)was used to measure the depression symptoms,the Barthel Index(BI),and the Modified Rankin Scale(m RS)were used to measure the activities of daily living.Descriptive statistical analysis was performed on the sociodemographic characteristics and disease-related characteristics of patients using mean ± standard deviation,frequency and percentage.Function,emotion,quality of life,and activities of daily living were described;the General Linear Mixed Model was used to explore the effects of perceived control on cognitive function,emotion,quality of life,and activities of daily living.Firstly,univariate analysis was conducted,and variables with statistically significant influence(P < 0.1)were analised according to model ⅰ: perception;Model ⅱ: Perception control + stroke severity and stroke risk factors;Model ⅲ: Multifactor analysis was conducted by perceived control + stroke severity and stroke risk factors + demographic sociological information,and P < 0.05 was considered to be statistically significant.The project was approved by the Medical Ethics Committee of Naval Military Medical University.Results1.Completion of follow-up and demographic and sociological data of patients: In this study,250 patients with acute ischemic stroke were investigated during the acute hospitalization of the subjects,233 patients were followed up at T1,and 5 patients dropped out,including 1 death,4 lost to follow-up,and another.12 did not come to the follow-up on time;209 completed the follow-up at T2,36 dropped out,1 case died,35 cases were lost to the follow-up,and 12 did not arrive on time at T1 to visit again.In this study,5 patients who were lost to follow-up from baseline were excluded,and a total of 245 patients with acute ischemic stroke were included in the data analysis.Among the 245 participants,63.67%were males,the average age was 63.03±9.07 years;All ethnic groups are Han;The proportion of patients with agricultural household registration was 48.97%,the proportion of patients with employment was 56.73%,the average year of education was 4.93±4.64 years,and the proportion of patients with spouse was 92.65%.The median NIHSS score at admission was 2(1,4.5)and at discharge was 1(0,2).The average day of hospitalization was9.22±5.09 days.Clinical manifestations(OCSP)were classified as complete anterior circulation infarction in 8 cases(3.27%),partial anterior circulation infarction in 57 cases(23.26%),posterior circulation infarction in 99 cases(40.41%),lacunar infarction in 81 cases(33.06%).The etiological types(TOAST)were as follows: 96 cases were atherosclerotic type(39.18%),15 cases were cardiogenic infarction(6.12%),86 cases were small artery occlusion type(35.10%),18 cases were other etiological types(7.35%),and 30 cases(12.25%)were unknown etiological type.2.Perceived control level: The average scores of perceived control in acute ischemic stroke patients in this study at T0,T1,and T2 were 85.32±17.56、86.31±12.47,and89.14±11.90,respectively.In the three periods of this study,perceived control was at a moderate level.There was no significant change in perceived control over time(β=1.05,P=0.10),Kruskal-Wallis H test was used to compare the proportion of patients with different levels of perception control at three time points,and the difference was not statistically significant(χ2=4.91,P=0.0861).3.Function,emotion,quality of life: the mean scores of cognitive function(Mo CA scale)in patients with acute ischemic stroke at T0,T1,and T2 in this study were: 18.99±6.18,21.74±5.72,and 22.73±6.50,respectively,which showed a rising trend(β=1.74,p<0.001).The cognitive function of the patients improved over time with statistically significant,Cochran-Armitage trend analysis was used to test the trend of the proportion of patients with cognitive impairment,the proportion of cognitive impairment showed a downward trend,and the difference was statistically significant(Z=4.83,P < 0.0001).The mean score of activities of daily living at T0,T1,and T2(BI)were 79.84±22.48,94.64±13.71,and95.07±14.79,showing an upward trend(β=7.60,p<0.001).The activities of daily living of the patients improved over time with statistically significant.The proportions of patients with m RS score above 3 at T0,T1,and T2 were: 31.44%,14.16%,and 15.31%,respectively,Cochran-Armitage trend analysis was used to test the trend of the proportion of patients with combined disabilities,and the proportion of patients with disabilities All showed a downward trend after the disease,and the results were statistically significant(Z=4.36,P <0.0001).The average scores of depressive symptoms(CES-D scale)at T0,T1,and T2 were15.39±10.43,9.52±6.98,and 9.52±8.47,respectively,showing a downward trend(β=-3.44,p<0.001).The depression symptoms of the patients decreased over time with statistically significant,Cochran-Armitage trend analysis was used to test the trend of the proportion of patients with depression,and the differences were as follows: Statistically significant,(Z=7.72,P < 0.0001),the proportion of depressed patients showed a downward trend after the disease.The mean scores of quality of life(SV-SS-Qo L scale)were42.13±10.79,46.56±8.43,and 47.16±8.92 at T0,T1,and T2,respectively,showing an upward trend(β=2.48,p<0.001).The quality of life of the patients improved over time with statistically significant.4.Effects of perceived control in different periods on cognitive function,emotion,quality of life,and activities of daily living in patients with acute ischemic stroke.(1)The effect of perceived control on cognitive function in different periods: after controlling the effects of time(β=1.80,p<0.001),NIHSS score at admission(β=-0.27,p<0.01),first stroke(β=1.63,p=0.01),age(β=-0.13,p<0.001),years of education(β=0.48,p<0.001),agricultural household registration(β=-2.46,p<0.01)on cognitive function,Patients with different levels of perceived control had different level of cognitive function in different periods(β=0.02,p=0.02).The higher the level of perceived control,the better the cognitive function.(2)The effect of perceived control on activities of daily living(BI)in different periods: after controlling for the effects of time(β=7.49,p<0.001)and NIHSS score at admission(β=-2.01,p<0.001)on activities of daily living,the Patients with different levels of perceived control had different activities of daily living in different periods(β=0.19,p<0.001).The higher the level of perceived control,the stronger the activities of daily living.(3)The effect of perceived control on depressive symptoms in different periods: after controlling the effects of time(β=-3.23,p<0.001),NIHSS score at admission(β=0.43,p<0.001),days of hospitalization(β=0.56,p<0.001),agricultural household registration(β=-2.12,p=0.01)on depressive symptoms in different periods,patients with different levels of perceived control had different levels of depressive symptoms in different periods(β=-0.14,p<0.001),the higher the perceived control level,the lower the level of depressive symptoms.(4)The effect of perceived control on the quality of life in different periods: after controlling the effects of the time(β=2.28,p<0.001),treatment method(arterial thrombectomy vs conservative treatment)(β=4.35,p<0.05),the NIHSS score at admission(β=-1.00,p<0.001),age(β=-0.12,p=0.01)on the quality of life in different periods,the impact of perceived control on the quality of life in different periods is still significant(β=0.15,p<0.001).The higher level of the perceived control the higher level of the quality of life in different periods.5.Analysis of the mediating effect of depression in the relationship between perceived control and cognition,function,and quality of life(1)The mediating effect of depression in the relationship between perceived control and cognition: During acute hospitalization: after controlling for the effects of covariates,the direct effect of perceived control on cognitive function(β=0.03,p=0.20),The indirect effect of perceived control on cognitive function through depressive emotion(β=0.005,p=0.24)and the total effect of perceived control on cognitive function(β=0.03,p=0.36)were not significant;3 months after onset The direct effect(β=0.18,p<0.001)and total effect(β=0.17,p<0.001)of post-perceived control on cognitive function were significant,and the indirect effect of perceived control on cognitive function through depression(β=-0.02,p=0.56)was not significant;after 6 months after onset,the direct effect(β=0.19,p<0.001)and total effect(β=0.21,p<0.001)of perceived control on cognitive function were significant,and perceived control passed The indirect effect of depression on cognitive function(β=0.02,p=0.44)was not significant,and the effect of perceived control on cognitive function was positive,but the mediating effect of depression was not significant.(2)The mediating effect of depression on the relationship between perceived control and activities of daily living: acute hospitalization: after controlling for the effects of covariates,the direct effect of perceived control on activities of daily living(β=0.003,p=0.88)and total effect(β=0.03,p=0.68)were not significant,the indirect effect(β=0.02,p=0.04)of perceived control on activities of daily living through depression was significant,and the mediating effect was not significant;3 months after onset : The direct effect of perceived control on activities of daily living(β=0.13,p=0.16)is not significant,the indirect effect of perceived control on activities of daily living through depression(β=0.30,p<0.001)and the effect of perceived control on activities of daily living(β=0.30,p<0.001)The total effect of activities of living(β=0.43,p<0.001)was significant,and the mediating effect was not significant;6 months after the onset: the direct effect of perceived control on activities of daily living(β=0.22,p<0.001),perceived control The indirect effect of depression on activities of daily living(β=0.13,p<0.001)and the total effect of perceived control on activities of daily living(β=0.35,p<0.001)were both significant.The effect was positive,and depressive was a mediating variable between perceived control and activities of daily living.(3)The mediating effect of depression in the relationship between perceived control and quality of life: acute hospitalization: after controlling for the effects of covariates,the direct effect of perceived control on quality of life(β=0.02,p<0.001),perceived control Both the indirect effect of depression on quality of life(β=0.08,p<0.001)and the total effect of perceived control on quality of life(β=0.10,p<0.001)were significant;3 months after onset:perceived control on quality of life The direct effect of perceived control on quality of life(β=0.19,p<0.001),the indirect effect of perceived control on quality of life through depressive(β=0.14,p<0.001),and the total effect of perceived control on quality of life(β=0.33,p<0.001))were significant,6 months after onset: direct effect of perceived control on quality of life(β=0.22,p<0.001),indirect effect of perceived control on quality of life through depressive(β=0.15,p<0.001)and perception The total effect of control on quality of life(β=0.37,p<0.001)was significant.The impact of perceived control on quality of life was positive,and depression was a mediating variable in the relationship between perceived control and quality of life.ConclusionStroke damages multiple functions of patients,affects patients’ emotions and leads to a decline in patients’ activities of daily living and quality of life.As a personality trait,perceived control,affects the cognitive function,activities of daily living,emotion,and quality of life of patients with acute ischemic stroke positively.Emotion was the mediating variable in the relationship between perceived control and quality of life at three time points,and was the mediating variable in the relationship between perceived control and activities of daily living at 6 months after onset.Perceived control is a potential starting point for the health management and rehabilitation of stroke patients,and through interference in perceived control,it is expected to reduce the level of depression and other negative emotions in patients,thereby improving patients’ cognitive function,reducing disability,and improving activities of daily living and quality of life. |
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