Dynamics of perceived social isolation, secondary conditions, and daily activity patterns among individuals with stroke: A network analysis of ecological momentary assessment data.

OBJECTIVE: To assess contemporaneous and temporal dynamics of perceived social isolation (PSI), secondary conditions, and daily activity patterns in individuals post-stroke.

DESIGN: Longitudinal observational study using ecological momentary assessment (EMA) as a real-time assessment of an individual's lived experiences. We conducted dynamic network analyses to examine longitudinal associations among EMA variables.

SETTINGS: Home and Community PARTICIPANTS: 202 individuals with mild-to-moderate chronic stroke (median age = 60 years; 45% female; 44% black; 90% ischemic stroke; median NIHSS score = 2) INTERVENTION: Not applicable MAIN OUTCOME MEASURES: EMA questions measured PSI, secondary conditions (pain, tiredness, stress, anxiety, worthlessness, difficulty concentrating, and cheerfulness), and daily activity patterns (being at home, being alone, and participating in productive activities).

RESULTS: The median EMA response rate was 84%. The contemporaneous model showed that PSI was associated with being home, alone, and all symptoms except pain. The temporal model revealed a pathway indicating that feelings of worthlessness predicted PSI (regression coefficient = 0.06, p = 0.019), followed by stress (regression coefficient = 0.06, p = 0.024), and then by being not at home (regression coefficient = -0.04, p = 0.013).

CONCLUSION: Implementing dynamic network analyses on EMA data can uncover dynamic connections among PSI, secondary conditions, and daily activity patterns after stroke. This study found a significant temporal association between PSI and negative emotions. Feeling isolated was followed by feeling stressed, which was followed by a tendency to be out of home, indicating adaptive behaviors in individuals with stroke. These findings highlight the importance of engaging in out-of-home or outdoor activities to mitigate PSI and negative emotions.