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Psychophysiological Effects of an Expressive Arts-based Intervention in Young and Pre-elderly Stroke Survivors: A
Rainbow T H Ho1, Temmy L T Lo2, Ted C T Fong3
1Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong; Department of Social Work and Social Administration, The University of Hong Kong.
Objective:
To examine the psychophysiological effects of an 8-week expressive arts-based intervention (EABI) on young and pre-elderly stroke survivors.
Design:
A parallel-group randomized controlled trial.
Setting:
Public hospitals and community sites.
Participants:
Community-dwelling participants (N=157) aged between 18 and 64 years who experienced a major stroke event in the past 10 years with mild to moderate post-stroke impairments (modified Rankin scale level=1-4).
Interventions:
Participants were randomly assigned to an 8-week EABI group (N=75) once per week for 90 minutes or a treatment-as-usual waitlist control group (CG) (N=82).
Main Outcome Measures:
Outcomes of psychophysiological functioning, including depression, anxiety, perceived social support, hope, self-esteem, generic and stroke-specific quality of life (QOL), and salivary cortisol, were measured at three assessment waves: baseline (T0), 2 months after baseline (T1), and 8 months after baseline (T2). The short-term (T0-T1) and long-term (T0-T2) effects of the EABI were analyzed by latent change analysis. Mediation analysis was conducted to explore the potential mechanisms of the short-term and long-term EABI effects.
Results:
From T0 to T1, the EABI group showed significant improvements in perceived social support, hope, and self-esteem (Cohen d=0.32-0.48) compared with the CG. From T0 to T2, there were significant improvements in anxiety symptoms and self-esteem, physical QOLs, and wake-up cortisol (d=0.34-0.46). Short-term improvements in perceived social support and hope partially mediated the long-term EABI effects on physical QOLs. The beneficial effects of EABI showed heterogeneity across gender and stroke types.
Conclusions:
This study found short-term effects for the EABI on perceived social support and hope and long-term effects on self-esteem and physiological functioning. Future research should develop tailored EABI as multifaceted support for rehabilitation practice for stroke survivors.
