Date of Award

Summer 8-6-2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Dawn Aycock PhD, RN ANP-BC, FAHA

Second Advisor

Kimberly Hires, PhD, RN

Third Advisor

Jonathan Grossberg, MD

Abstract

PRESENCE OF PSYCHOSOCIAL SYMPTOMS IN YOUNG ADULT STROKE SURVIVORS POST-ACUTE THROMBECTOMY FOR ISCHEMIC STROKE

Young adults are the fastest growing population of stroke patients. Current treatments enable physicians to reverse hyper-acute large vessel ischemic stroke, and young adult stroke survivors (YASS) are increasingly discharged directly home with few to no apparent neurological deficits. No studies have examined the psychosocial experiences these YASS have once they are home and whether these experiences are associated with stroke-specific quality of life (SSQOL). The purpose of this study was to describe YASS post-stroke symptoms, their understanding and perception of those symptoms, and to examine relationships among psychosocial variables: anxiety, depression, fatigue, illness threat perceptions and SSQOL. A cross-sectional, exploratory design was used. YASS 18-55 years of age and 1- 18 months post-stroke who received a thrombectomy at a metropolitan, comprehensive stroke center and discharged directly home were recruited. Demographic and clinical data (e.g. NIHSS, mRS scores) were collected from the hospital’s electronic medical record. Participants completed questionnaires to assess psychosocial variables using an online or paper survey. Data were analyzed using SPSS version 25. Descriptive statistics and Spearman rho correlations were performed. Participants (N = 14) had a mean age 45 years (SD = 6.2), were 4-18 months poststroke, 71% female, 57% Black, and had discharge NIHSS scores indicating minimal vii neurological deficits (M = 2, SD = 2.6). Five participants were identified as having clinically severe fatigue; three had borderline cases. There was one case of clinically significant anxiety with one borderline case, and one case of clinically significant depression with three borderline cases. All participants perceived some level of threat of the symptoms they were experiencing, and overall SSQOL was decreased. Higher levels of fatigue, anxiety, depression and illness perception threat were significantly related to lower SSQOL. In spite of being discharged home with minimal to no physical deficits, this sample of YASS described psychosocial symptoms, notably fatigue, that may impact recovery and transition back to the community. Further research is needed with a larger sample of these YASS to evaluate their psychosocial needs. Symptom assessments, provision of education, resources and ongoing support before and after discharge home may be beneficial.

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