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.