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A Structural Equation Model on Social Re-Adjustment of Stroke Patients: Based on Roy's Adaptation Model

뇌졸중 환자의 사회재적응 구조모형: Roy의 적응모형에 기반하여

  • Received : 2022.11.14
  • Accepted : 2023.07.24
  • Published : 2023.08.31

Abstract

Purpose: This study aimed to develop and test a structural equation model on social re-adjustment of individuals with stroke based on a literature review and Roy's adaptation model. Methods: This study involved 321 participants who had a stroke and visited the outpatient department after discharge. The hypothetical model was developed based on Roy's adaptation model and a comprehensive review of previous literature on the topic. The model comprised four exogenous variables (neurological damage, gender [man], age, and social support) and five endogenous variables (activities of daily living, acceptance of disability, depression, rehabilitation motivation, and social re-adjustment). The data were analyzed using SPSS Windows software version 22.0 and AMOS 23.0. Results: Out of 28 research hypotheses, 18 were supported, and they indicated approximately 64% probability of social re-adjustment. Social re-adjustment is directly and significantly affected by age, social support, activities of daily living, and depression. Social re-adjustment is indirectly affected by neurological impairment, gender (men), age, social support, and rehabilitation motivation. Conclusion: Continuous assistance and care should be provided for individuals with disabilities caused by sudden neurological damage to facilitate gradual improvement in their social re-adjustment. To enhance social re-adjustment, especially among older adults, newly developed interventions should focus on improving their activities of daily living, preventing depression, and enhancing support from family and healthcare personnel.

Keywords

References

  1. Statistics Korea. 2021 Statistics on causes of death [Internet]. Daejeon: Statistics Korea; c2022 [cited 2022 Sep 27]. Available from: https://kostat.go.kr/board.es?mid=a10301060200&bid=218&act=view&list_no=420715.
  2. Kang SH, Choi YJ, Lee KH, Kim YH, Chang WH, Shin MA, et al. The Korean stroke cohort for functioning and rehabilitation (KOSCO). Public Health Weekly Report. 2018;11(35): 1152-1162.
  3. Baek SH, Shin JI. A systematic review on the caregivers burden of stroke patients. The Journal of Occupational Therapy for the Aged and Dementia (OTAD). 2018;12(1):45-54. https://doi.org/10.34263/jsotad.2018.12.1.45
  4. Suh MJ. A study of factors influencing the state of adaptation of hemiplegic patients. Journal of Nurses Academic Society. 1990;20(1):88-117. https://doi.org/10.4040/jnas.1990.20.1.88
  5. Lee JA. A study on the impact of acceptance of disability and social support on rehabilitation motivation in stroke patients [master's thesis]. Gwangju: Nambu University; 2012. p. 1-76.
  6. Oh HK, Lee HS. The effect of physical function and social support on social participation of noncongenital-spinal injured persons: Focused on the mediating effect of acceptance of disability. Journal of Rehabilitation Research. 2011;15(2):1-23.
  7. Heo JY, Kim CH, Kim YK. The relationship of NIH (National Institutes of Health) stroke scale to functional improvement in stroke patients. The Journal of Korean Academy of Physical Therapist. 2002;9(1):103-111.
  8. Roh SH. A study on factors influencing acceptance of disability of physically disabled elders: In comparison with disabled middle aged individuals. Journal of Rehabilitation Research. 2007;11(1):30-60.
  9. Park SJ. Factors influencing post stroke depression in acute stroke patients. The Journal of the Korea Contents Association. 2020;20(10):385-394. https://doi.org/10.5392/JKCA.2020.20.10.385
  10. Yang JB. A study on the major factors affecting health-related quality of life of elderly stroke survivors. Journal of the Korean Gerontological Society. 2010;30(4):1239-1261.
  11. Cho NO, Suh MJ, Kim KS, Kim IJ, Choi HJ, Jung SH. Social readjustment and relating factors in stroke survivors. Journal of Korean Academy of Adult Nursing. 2001;13(1):96-107.
  12. Kim HM. A study on the relationship between disability acceptance and social network of the physically disabled [master's thesis]. Kongju: Kongju National University; 2005. p. 1-63.
  13. Kim MH. Acceptance of disability and related factors of hemiplegic elderly and non-elderly. Journal of Korean Academy of Adult Nursing. 2009;21(5):547-558.
  14. Bae JH. The structural analysis of variabls related to quality of life in middle-aged patients with stroke [dissertation]. Daegu: Daegu Catholic University; 2016. p. 1-79.
  15. Oh SY. A prediction model for rehabilitation motivation among the middle-aged stroke patients in rehabilitation period [dissertation]. Seoul: Hanyang University; 2017. p. 1-106.
  16. Kim YR. LA study of the relationships among the social support, academic self-concept, and the test anxiety of the high school students. Student Life Study. 2004;9:115-131.
  17. Dharma KK, Nurbani N, Wardhani P, Rangkuti WF, Rahayu H, Kapadia R. The factors that influence the adaptation process 6 months after a stroke: A path analysis. Enfermeria Clinica (English Edition). 2023;33(1):30-37. https://doi.org/10.1016/j.enfcle.2022.06.003
  18. Lim YM, Ham MJ, Hwang HS, Kim H. The effect of disability acceptance and anxiety on participation of people with stroke living in the community. The Journal of the Korea Contents Association. 2022;22(1):591-600. https://doi.org/10.5392/JKCA.2022.22.01.591
  19. Jeong HM. Relationships among depression, acceptance of disability and coping skills in post-stroke elderly women [master's thesis]. Gyeongsan: Daegu Catholic University; 2011. p. 1-38.
  20. Jang HJ, Seo JH, Kim JY, Sung WY, Lim HJ, Kim JW, et al. A study on relationship between the post-stroke depression and acceptance. Journal of Oriental Neuropsychiatry. 2006;17(2):167-177.
  21. Lee MH, Oh SY. The mediating effects of self-efficacy on depression and rehabilitation motivation in stroke patients. The Journal of Humanities and Social Science. 2020;11(3): 927-939. https://doi.org/10.22143/HSS21.11.3.66
  22. An HS, Jeon BR, Choi SE, Choi YS, Kim DJ. The effect of mental health and quality of life on quality of sleep in stroke patients. Journal of Korea Aging Friendly Industry Association. 2022;14(2):1-12. https://doi.org/10.34264/jkafa.2022.14.2.1
  23. Choi ES, Lee EN, Cho JL. The mediating effect of resilience on depression and rehabilitation motivation in stroke patients. The Journal of Muscle and Joint Health. 2016;23(1):19-27. https://doi.org/10.5953/JMJH.2016.23.1.19
  24. Farner L, Wagle J, Engedal K, Flekkoy KM, Wyller TB, Fure B. Depressive symptoms in stroke patients: A 13 month follow-up study of patients referred to a rehabilitation unit. Journal of Affective Disorders. 2010;127(1-3):211-218. https://doi.org/10.1016/j.jad.2010.05.025
  25. Lee JY, Kim HS. Influences of social support, self-esteem and motivation for rehabilitation on the activities of daily living in stroke patients. Journal of East-West Nursing Research. 2014;20(2):145-153. https://doi.org/10.14370/jewnr.2014.20.2.145
  26. Roy C, Andrews HA. The Roy adaptation model. 2nd ed. Stamford (CT): Appleton & Lange; 1999. p. 574.
  27. Park SJ. Longitudinal changes in health-related quality of life among patients with tuberculosis: An application of Roy's adaptation model [dissertation]. Gwangju: Chonnam National University; 2017. p. 1-86.
  28. Song IJ. Change the quality of life according to elapsing time in stroke patient [dissertation]. Gwangju: Chonnam National University; 2012. p. 1-90.
  29. Pollock SE. Human responses to chronic illness: Physiologic and psychosocial adaptation. Nursing Research. 1986;35(2):90-97. https://doi.org/10.1097/00006199-198603000-00008
  30. Kim MY. Theory: Roy's adaptation model. Journal of Nursing Query. 2006;14(2):49-69.
  31. Kim IJ, Suh MJ. The prediction model of adaptation in patients with rheumatoid arthritis - propositional synthesis of Roy's and Lazarus & Folkman's theory -. The Journal of Muscle and Joint Health. 1997;4(2):197-220.
  32. Ferrin JM, Chan F, Chronister J, Chiu CY. Psychometric validation of the Multidimensional Acceptance of Loss Scale. Clinical Rehabilitation. 2011;25(2):166-174. https://doi.org/10.1177/0269215510380836
  33. Woo JP. Professor Woo Jong-pil's concept and understanding of the structural equation model. Seoul: Hannaraeacademy; 2016. p. 568.
  34. Lee KM, Jang YH, Kim YH, Moon SK, Park JH, Park SW, et al. Reliability and validity of Korean version of national institutes of health stroke scale: Multi-center study. Journal of Korean Academy of Rehabilitation Medicine. 2004;28(5):422-435.
  35. Kim HM. A study on the effects of stroke patients' activities of daily living, depression and social support for them on their life quality [master's thesis]. Seoul: Hanyang University; 2005. p. 1-66.
  36. Won CW, Rho YG, Kim SY, Cho BR, Lee YS. The validity and reliability of Korean activities of daily living (K-ADL) scale. Journal of the Korean Geriatrics Society. 2002;6(2):98-106.
  37. Won CW, Rho YG, SunWoo D, Lee YS. The validity and reliability of Korean instrumental activities of daily living (K-IADL) scale. Journal of the Korean Geriatrics Society. 2002;6(4):273-280.
  38. Shong OH. A study of the self-rating depression scale (SDS) on psychiatric out-clnic patients. Journal of the Korean Neuropsychiatric Association. 1977;16(1):84-94.
  39. Kline RB. Principles and practice of structural equation modeling. 3rd ed. New York (NY): Guilford Press; 2011. p. 427.
  40. Shin JY, Choi EY, Kong M. Effects of self-efficacy and disability acceptance on social integration in people with traffic-related disabilities and the mediating effect of motivation. Journal of Special Education & Rehabilitation Science. 2015;54(2):501-522. https://doi.org/10.15870/jsers.2015.06.54.2.501
  41. Moon SK, Park EY, Choi JH. The study for relationship between activities of daily living and stress for the physically disabled elderly using community welfare center, and the medication effect of participating social role. Korean Journal of Social Welfare Research. 2009;21:203-224.
  42. Song YW, Kim SK. Factors influencing on social participation in patients with stroke. Journal of the Korea Academia-Industrial Cooperation Society. 2017;18(6):165-170. https://doi.org/10.5762/KAIS.2017.18.6.165
  43. Kwakkel G, Wagenaar RC, Kollen BJ, Lankhorst GJ. Predicting disability in stroke--a critical review of the literature. Age and Ageing. 1996;25(6):479-489. https://doi.org/10.1093/ageing/25.6.479
  44. Samsa GP, Matchar DB. How strong is the relationship between functional status and quality of life among persons with stroke? Journal of Rehabilitation Research and Development. 2004;41(3A):279-282. https://doi.org/10.1682/jrrd.2003.08.0117
  45. Shin EK, Choi JA. Study on factors affecting on the spinal cord injuries' social integration using the structural equation model: Analyzing mediating effect of depression, disability identity. Journal of Rehabilitation Research. 2007;11(1):1-26.
  46. Choi KS, Chi SA, Ham MY. An ethnographic study of the experience of stroke recovery. The Chung-Ang Journal of Nursing. 2003;7(1):1-7.
  47. Kim JH, Kang HS, Kim WO, Wang MJ, Chang CM. Factors affecting the quality of life in stroke patient at home. The Korean Journal of Rehabilitation Nursing. 2006;9(1):49-55.
  48. Kim WH, Hwang MO, Park EY. The effect of physical and occupational therapy on activities of daily living in stroke inpatients at least 3 months after stroke. Physical Therapy Korea. 2007;14(1):74-81.
  49. Nam YH, Kim YS, Han SG. A study on factors influencing the independent living of people with spinal cord injury. Journal of Rehabilitation Research. 2013;17(3):1-29.
  50. Kim SJ, Kim YS, Choi NK, Lee YY, Lee BC, Lee MH. Quality of life of patients in acute stage of stroke. Korean Journal of Psychosomatic Medicine. 2002;10(1):27-36.