Chronic Subdural Hematoma and the Longitudinal Trajectory of Intrinsic Capacity: A Cross-Lagged Panel Network...

Chronic subdural hematoma (CSDH) is a common neurosurgical condition among older adults. Although surgical success rates are high, many patients experience poor multidimensional functional recovery postoperatively, significantly affecting their quality of life and increasing care burden. The World Health Organization's "intrinsic capacity" framework offers a comprehensive perspective for assessing functional status; however, the dynamic changes in intrinsic capacity after CSDH surgery remain poorly understood.

This study applied longitudinal network analysis to dynamically explore the causal interactions among 6 domains of intrinsic capacity-locomotion, cognition, psychology, vitality, vision, and hearing-in CSDH patients from presurgery to 3 months postsurgery. The aim was to identify core driving factors across different recovery phases and to provide a basis for developing time-sensitive nursing interventions.

A longitudinal observational study.

We assessed a cohort of 172 postsurgical chronic subdural hematoma (CSDH) patients at 4 time points: preoperative (T0), 1-week (T1), 1-month (T2), and 3-month (T3) postoperatively, using a standardized digital tool. For the intervals T0→T1, T1→T2, and T2→T3, we constructed directed, temporal cross-lagged panel networks (CLPNs) through LASSO-regularized regression. Core domains within the networks were identified by computing their out-expected and in-expected influence (out-EI/in-EI). Network stability was rigorously evaluated using bootstrap resampling.

The intrinsic capacity network exhibited marked dynamic restructuring throughout the recovery period. In the initial T0→T1 phase, vision emerged as the principal network driver (highest out-EI), exerting a strong positive influence on hearing. Vitality positively predicted cognition while being negatively associated with locomotion. During the T1→T2 interval, hearing superseded vision as the main driver, and psychological status imposed a persistent negative effect on cognition. In the final T2→T3 stage, vitality and hearing served as co-drivers of network effects, while cognition and psychology became the primary receivers of network effects (highest in-EI). The stability was acceptable for the T0→T1 and T2→T3 networks (CS-coefficient >0.25).

The post-CSDH recovery of intrinsic capacity was characterized by distinct, stage-specific causal pathways. Early interventions should strategically target sensory function and vitality. In the mid-to-late phase management, it's necessary to proactively address the adverse impact of psychological state on cognition and simultaneously harness vitality as a positive lever. These findings furnish a dynamic evidence base for the implementation of timely, precise, and personalized nursing rehabilitative interventions.