Looking on the bright side helps with poststroke recovery

Jairia Dela Cruz
14 Mar 2023
Looking on the bright side helps with poststroke recovery

When it comes to functional recovery after stroke, the adage “always look on the bright side” appears to be true, with a recent study providing evidence that optimism is associated with better recovery.

In a cohort of stroke survivors who were undergoing rehabilitation, those who answered positively to the question “Are you optimistic about the future?”, especially those who had no depression, showed the fastest recovery.

Total Functional Independence Measure (FIM) scores in the first 3 months increased by 24.0 points (95 percent confidence interval [CI], 22.5–25.4) for participants in the optimistic/without depression group and by 21.1 points (95 percent CI, 18.6–23.6) for those in the optimistic/with depression group. Little to no changes in FIM scores were observed in the following 9 months: −0.3 point (95 percent CI, −2.3 to 1.7) and 0.7 point (95 percent CI, −2.8 to 4.1), respectively. [J Am Heart Assoc 2023;doi:10.1161/JAHA.122.027959]

In contrast, recovery occurred at a slower rate for participants in the nonoptimistic groups, who had smaller changes in total FIM scores in the first 3 months: 16.7 points (95 percent CI, 10.9–22.4) in the nonoptimistic/without depression group and 10.2 points (95 percent CI, 6.0–14.5) in the nonoptimistic/with depression group. These groups showed continued recovery through 12 months, with additional improvements in scores of 8.7 (95 percent CI, −0.3 to 17.7) and 7.4 (95 percent CI, 1.0–13.7), respectively.

Optimism and depression were synergistically associated with functional recovery after stroke, as evidenced by a robust effect modification between optimism and depression (pinteraction<0.001).

“These findings build on prior work in Stroke Recovery in Underserved Populations (SRUP) Study, highlighting the role of positive emotions or depressive symptoms with functional recovery after stroke,” according to investigators from the University of Pennsylvania, in Philadelphia, Pennsylvania, US. [Rehabil Psychol 2010;55:33-39; Psychosom Med 2008;70:404-409; Arch Phys Med Rehabil 2022;103:1345-1351]

The investigators pointed out the potential of considering the presence or absence of optimism when evaluating stroke recovery, regardless of depression status.

“Given our findings of participants who are nonoptimistic and depressed exhibiting the most limited 12‐month recovery after stroke, measures of optimism and depression status at baseline may identify populations at risk for poor recovery; thus, there may be an opportunity for intervention, such as medications or cognitive‐behavioural therapy, to ameliorate the risk of poor recovery,” they said.

The study included 879 participants (mean age 68 years, 52 percent women, 74 percent White) across 11 inpatient rehabilitation facilities in the US. Of these, 581 participants were in the optimistic/without depression group, 197 in the optimistic/with depression group, 36 in the nonoptimistic/without depression group, and 65 in the nonoptimistic/with depression group. Depression was defined as Center for Epidemiologic Studies Depression scale score of >16.

Positive outlook equates to physical wellness

Psychological health is getting widely recognized as an important contributor to the body’s health and recovery after a physical illness. Moreover, there is a body of evidence linking cardiovascular disease risk with not only negative emotions (eg, depression and anxiety) or positive emotions (eg, joy or gratitude) but also specific psychological traits such as optimism. [Heart Lung Circ 2019;28:1812-1818]

“The influence of psychological health may be attributable to indirect behavioural mechanisms and direct physiologic mechanisms. There has been a positive association between optimism and better health behaviours, including better dietary and physical activity habits,” the investigators pointed out. [J Acad Nutr Diet 2014;114:1036-1045; Front Cardiovasc Med 2021;8:788194]

“In addition, associations between optimism and physical function are found in multiple pathophysiologic mediators of chronic disease, including inflammation, impairments in endothelial function, metabolic activity, blood pressure, ambulatory blood pressure, and hypothalamic‐pituitary‐adrenocortical function,” they said. [Psychosom Med 2010;72:134-140]

However, the investigators acknowledged that the direct mechanisms underlying the association between optimism and recovery after disease and its interaction with mood have yet to be addressed. They called for further research to assess whether optimism that is enhanced through directed intervention strategies after stroke has similar health effects, as well as to examine characteristics that allow one to be optimistic and depressed or pessimistic and not depressed in order to elucidate the interaction of optimism with mood.

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