Poster Presentation

Monday, November 5, 2007
10:30 AM - 11:45 AM

Monday, November 5, 2007
1:45 PM - 3:00 PM
This presentation is part of : Rising Stars Posters
Comeback of the Appalachian Female Stroke Survivor: Interrelationships between Cognition, Functional Ability, Self-Concept, Interpersonal, and Social Relationships
Patricia M. Vanhook, APRN, CNRN, DSN(c), Center for Nursing Research, East Tennessee State University, Johnson City, TN, USA
Learning Objective #1: will be able to describe comeback of Appalachian women who survive stroke
Learning Objective #2: will be able to identify psychometric tools used by the researcher to quanitatively measure comeback

Introduction:  Comeback: The process of overcoming disability is one of the nine phases described in the Chronic Illness Trajectory Framework (Corbin & Strauss, 1991).  This study is focused on the Appalachian female stroke survivor and hypothesizes: if the stroke survivor regains cognition and function (physical healing) through rehabilitation procedures, positively envelopes a new self-concept (biographical reengagement), and positively engages in interpersonal and social (psychological coming to terms) then comeback is achieved. Stroke is the number one cause of disability in the United States (American Heart Association [AHA], 2005). Of the population, aging women are at greater risk for stroke and have a greater incidence of disability leading to long-term care (Kelly-Hayse et al., 2003). However, little is known about women who survive stroke and who continue to live in the community, especially in central Appalachia. This study will accomplish three purposes: 1) advance the theoretical model as data from the study will be used as a pilot to further define comeback in measurable terms 2) enhance nursing practice in the care of the stroke survivor 3) learn about the unique characteristics of the Appalachian female stroke survivor.

Methods: 46 female stroke survivors ages 40-78 who have survived an ischemic or hemorrhagic stroke at least one year, were independently living in a home environment, and were able to speak and understand English were recruited from Northeast Tennessee and Southwest Virginia. Demographic information and data was collected from three psychometric tools, the Stroke Impact Scale (3.0) (Duncan, Bode, Lia, & Perera, 2003), the Relationship Change Scale (Guerney, 1971), and the Health-Related-Quality-of-Life-4 Scale (Morarity, Zack, & Kobau, 2003).  Descriptive statistics (means and standard deviations) summarized patient characteristics. Continuous variables were analyzed using bivariate relationships expressed as Pearson correlation coefficients. The difference between groups (stroke severity and stroke type) and the measurement variables were analyzed using independent t-test and ANOVA. Lastly, multiple linear regressions were done to evaluate simultaneous effects of the independent variables.

Results: The mean age was 57 years with survivorship ranging from one to 36 years.  Function and cognition scores did not vary significantly from the established test range for the SIS V 3.0.  Women with moderate ischemic stroke scored statistically higher for recovery score (ρ<.001). A positive association was noted between health rating and recovery score (ρ<.001). Women who had rehabilitation scored less on recovery (ρ<.05), memory (ρ<.05), communication (ρ<.05), handicap (ρ<.05), and function (ρ<.05). Improved relationships were noted for women for women with minor (ρ<.05) and moderate (ρ<.001) stroke.Conclusions: The study demonstrated comeback can be defined by the relationships of physical healing, biographical reengagement, and coming to terms that support the theoretical propositions of the Trajectory Theory of Chronic Illness Management (Corbin & Strauss). A strong relationship exists among the phases representative of comeback, while rehabilitation procedures and interpersonal relationships demonstrated only modest significance.