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Psychological and behavioral processes in stroke survivors with recovery exceeding prognostic expectations: a
Ryu Kobayashi1, Norikazu Kobayashi2
1Department of Occupational Therapy, International University of Health and Welfare, Narita, Chiba, Japan.
Background:
Some patients demonstrate exceptional post-stroke recovery beyond prognostic expectations; this phenomenon is referred to as positive deviance. Understanding how such recovery is perceived in clinical practice may provide insights for improving rehabilitation.
Aim:
This study aimed to explore how occupational therapists perceive and interpret psychological and behavioral processes observed among stroke survivors whose activities of daily living (ADL) improvement exceeded prognostic predictions.
Methods:
A qualitative descriptive design was employed. Semi-structured interviews were conducted with eight occupational therapists working in a rehabilitation ward. The analysis focused on psychological and behavioral processes in patients with post-stroke ADL improvement beyond prognostic expectations, as perceived by the therapists. Data were analyzed inductively using reflexive thematic analysis.
Results:
Six themes were identified as common patterns of psychological and behavioral processes among the patients: 1) maintaining own identity based on occupation; 2) positive and flexible problem-solving orientation; 3) mental fortitude to face challenges; 4) self-management toward goal attainment; 5) development of self-efficacy through accumulated successful experiences; and 6) proactive use of social support.
Conclusions:
The psychological and behavioral processes associated with positive deviance, as perceived by occupational therapists, provide a clinically grounded perspective on stroke recovery and may inform the development of rehabilitation strategies to enhance recovery outcomes.
