Impact of coping strategies on occupational gaps in post-stroke dyads: mutual influence between stroke survivors and their caregivers.

INTRODUCTION

After a stroke, occupational gaps, defined as discrepancies between performed and desired activities, are common among stroke survivors and their caregivers. While dyadic interactions shape these gaps, the role of coping strategies remains underexplored. This study aimed to examine the association between coping strategies and occupational gaps in post-stroke dyads and identify associated sociodemographic, clinical, and psychosocial factors.

METHODS

We conducted a cross-sectional study including 33 stroke survivor-caregiver dyads (22 cohabiting) recruited during follow-up consultations (median = 7 months post-stroke). Occupational gaps were assessed with the Occupational Gaps Questionnaire, and coping strategies with the Brief COPE. Clinical measures included dependency, ambulation, cognition, fatigue, anxiety, and depression. Associations were examined using age-adjusted Spearman correlations and dyadic effects with the Actor-Partner Interdependence Model (APIM).

RESULTS

Sixty-four percent of stroke survivors reported occupational gaps, mainly in mobility, travel, sports, and cultural activities. Among cohabiting dyads, 41% of caregivers reported more gaps than survivors did, especially in the leisure and social domains. APIM showed partner effects in cohabiting dyads: caregivers' use of social support coping was associated with greater gaps in both members, while survivors' positive thinking was linked to fewer caregiver gaps (Ps = 0.02). Caregivers' avoidance coping was associated with greater personal gaps (P < 0.05). Greater survivor dependency was associated with higher gaps in both members (R > 0.60, P < 0.05), and survivors' cognitive score correlated negatively with caregivers' gaps (R = -0.61, P = 0.003). Among survivors living alone, gaps correlated with fatigue (R = 0.83, P = 0.002) and depressive symptoms (R = 0.81, P = 0.003).

CONCLUSION

Findings highlight the need for dyadic interventions that target coping strategies, promoting adaptive ones (positive reframing, acceptance) while addressing maladaptive ones (avoidance, excessive reliance on social support). Dyadic interventions may reduce participation restrictions and improve quality of life for survivors and caregivers.