Psychological resilience and functional recovery after acute ischemic stroke: a prospective cohort study

Psychological resilience has been proposed as a factor that may influence recovery after stroke, yet evidence regarding its independent contribution to functional outcomes remains limited and inconsistent. This study evaluated the association between baseline psychological resilience and longitudinal functional recovery following acute ischemic stroke during structured rehabilitation.

In this prospective cohort study, adult patients with imaging-confirmed acute ischemic stroke were enrolled during hospitalization and followed for 6 months. Psychological resilience was assessed using the 10-item Connor-Davidson Resilience Scale. Functional outcomes were measured using the modified Rankin Scale at 6 months and the Barthel Index at discharge, 3 months, and 6 months. Multivariable ordinal logistic regression was used to examine the association between resilience and functional outcome after adjusting for age, sex, stroke severity, comorbidity burden, rehabilitation exposure, and mood symptoms.

A total of 241 patients were included. Functional outcomes improved progressively over time, with the greatest gains observed during the early rehabilitation period. Baseline psychological resilience was associated with demographic and psychological characteristics but was not independently associated with functional recovery after adjustment for clinical factors. Sensitivity analyses using a binary definition of favorable outcome demonstrated an association between baseline stroke severity and recovery.

In this prospective cohort of patients undergoing stroke rehabilitation, psychological resilience was not an independent predictor of functional outcome. Recovery was primarily determined by established clinical factors. These findings suggest that resilience may influence adaptation to illness rather than neurological recovery itself.