Jump to comment:

• Coping strategies after stroke and their relationship to different outcomes
  Anne-Sophie E. Darlington
  Published on: 13 April 2016

• Published on: 13 April 2016

  Coping strategies after stroke and their relationship to different outcomes

  • Anne-Sophie E. Darlington
  • Other Contributors:
    • Diederik W.J. Dippel, Gerard M. Ribbers, Romke van Balen, Jan Passchier, Jan J.V. Busschbach

  Dear Editor,

  With interest we read the recent review by Donnellan et al.[1] on coping strategies after stroke. The review highlights the existing literature on coping strategies in stroke patients, in part with the aim to identify coping strategies that are typical for this patient group. In addition, the review investigates methodological issues in terms of definition and measurement of coping. The review makes i...

  Show More

  Dear Editor,

  With interest we read the recent review by Donnellan et al.[1] on coping strategies after stroke. The review highlights the existing literature on coping strategies in stroke patients, in part with the aim to identify coping strategies that are typical for this patient group. In addition, the review investigates methodological issues in terms of definition and measurement of coping. The review makes it abundantly clear that this area is in need of significant improvement, especially in stroke research.

  The authors also show that with the current data it is difficult to pinpoint certain coping strategies that are used either immediately after the stroke, or in the long term. However, we feel that the main question concerning the existence of specific coping strategies that are used by stroke patients, is perhaps less relevant than examining which coping strategies are related to important outcomes. The review mentions a limited number of studies that have related coping strategies to the outcome measure depression. Several coping strategies such as avoidance coping, decreased behavioural action, and apathy were related to depression.[1]

  While the relation between depression and coping is an important finding, depression as an outcome measure is somewhat one-sided because it does not cover multiple aspects of well-being. Quality of life (QoL) in recent years has received a lot of attention in healthcare research, as it attempts to measure the multiple aspects of well-being. Indeed research in stroke patients has shown that QoL of stroke patients is impaired.[2][3] We recently conducted a longitudinal study on coping strategies in stroke patients, all of which were discharged to go home, and related coping strategies to the patient’s QoL. The coping strategies were derived from the Dual Process Model of coping by Brandtstädter and Renner,[4] who describe coping in terms of adjusting or pursuing goals that existed before the stroke occurred. The study consisted of four measurement moments up to 9-12 months after discharge. Our results showed that while taking the level of physical functioning into account both coping strategies at baseline were positively and independently associated with QoL, at least 5 months after discharge.[5] These are significant findings of an exploratory study of relatively fortunate patients in terms of impaired physical functioning.

  Unlike traits such as neuroticism, which in fact tends to also be a strong determinant of outcome measures such as QoL, coping strategies are dependent on context and therefore in part modifiable. Patients who present with a poor perceived QoL relative to their physical impairment may benefit from an intervention designed to improve the way these patients cope with their impaired physical functioning. The challenge for the near future is in our view to further explore the relationship between coping and QoL of both patient and proxy. ‘Therapeutic’ approaches that may help stroke survivors to improve their coping behaviour should be developed and evaluated. Such studies should not only be directed to coping strategies in general (e.g. problem-focussed, emotion-focussed and adjusting/pursuing goals), but also to coping strategies in specific daily life situations (e.g. work, family and friends, leisure activities). Whether such approaches will be effective from a clinical and economical point of view should be evaluated as rigorously as in medical intervention research.

  Anne-Sophie E.Darlington

  References

  1. Donnellan C, Hevey D, Hickey A et al. Defining and quantifying coping strategies after stroke: a review. J Neurol Neurosurg Psychiatry 2006;77:1208-1218.

  2. Sturm JW, Donnan GA, Dewey HM et al. Quality of life after stroke. The North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2004;35:2340-2345.

  3. Paul SL, Sturm JW, Dewey HM, et al. Long-term outcome in the North East Melbourne Stroke Incidence Study: predictors of quality of life at 5 years after stroke. Stroke 2005;36:2082-2086.

  4. Brandtstädter J, Renner G. Tenacious goal pursuit and flexible goal adjustment: explication and age-related analysis of assimilative and accommodative strategies of coping. Psychol Aging 1990;5:58-67.

  5. Darlington ASE, Dippel DWJ, Ribbers GM, et al. Coping strategies as determinants of quality of life in stroke patients: A longitudinal study. Cerebrovasc Dis, in press.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top