Relationship between physical, psychological function, and post-discharge life-space mobility in older patients with mild ischemic stroke: A longitudinal mediation analysis
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Kento Muto1, Daijo Shiratsuchi2, Taisyu Matsumoto3
1Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, Aichi 453-8511, Japan; Department of Physical Therapy, Graduate Course of Rehabilitation Science, School of Health Sciences, College of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan.
Objective:
Life-space mobility (LSM) is a multidimensional indicator of real-world mobility. Identifying factors associated with LSM may be important for supporting community mobility after stroke. Because physical and psychological function may interact in shaping mobility-related behavior, understanding their relationships may provide a more comprehensive understanding of post-stroke LSM. This study aimed to longitudinally investigate whether physical function at discharge is directly related to post-discharge LSM and indirectly via psychological function in older patients with mild ischemic stroke.
Methods:
This observational study adhered to the STROBE guidelines. Patients ≥65 years with acute ischemic stroke were included. This study used a hypothesis-driven framework of structural equation modeling to clarify the relationship between physical function, psychological function, and LSM. Life-space assessment (LSA) was performed before hospitalization (Pre-LSA) and at 6 months after stroke onset (Post-LSA). Post-LSA was used as the primary outcome, with Pre-LSA and other relevant covariates included in the model.
Results:
We enrolled 184 patients (median age, 77 years; 64 women). Physical function was significantly associated with LSM at 6 months (β = 0.321, p = 0.018), whereas the indirect association through psychological function was small and statistically non-significant (β = 0.014, p = 0.774). However, the hypothesized model showed inadequate model fit.
Conclusions:
Physical function at discharge may be relevant to subsequent community mobility at 6 months in older patients with mild ischemic stroke; however, the model's fit is poor. Further studies using more comprehensive models are needed to clarify the determinants of long-term mobility after stroke.