Dynamics of social isolation, health-related symptoms, and daily activity patterns among individuals with stroke: An ecological momentary assessment study with network analysis

Research Objectives: To assess temporal and contemporaneous dynamics of social isolation, health-related symptoms, and daily activity patterns in individuals with stroke.

Design: We combined ecological momentary assessment (EMA) data with a network approach to examine the dynamic relations among social isolation, health-related symptoms, and daily activity patterns. Participants who used smartphones completed EMA surveys five times daily for 14 days.

Setting: Community

Participants: 202 participants with mild-to-moderate chronic stroke (median age: 60; 90% ischemic stroke; 45% female; 44% black).

Interventions: Not applicable

Main Outcome Measures: EMA questions assessing self-reported social isolation, health-related symptoms (pain, tiredness, stress, anxiety, worthlessness, difficulty concentrating, and cheerfulness), and daily activity patterns (being at home/not home, being alone/not alone, participating in productive/non-productive activities).

Results: The contemporaneous model showed that social isolation (bridge strength = 2.18) was associated with being alone and all symptoms except pain. The temporal networks revealed a pathway connecting social isolation, symptoms, and daily activity patterns: feelings of worthlessness predicted social isolation (coefficient = 0.06, p = 0.019), followed by stress (coefficient = 0.06, p = 0.024), and then by being not at home (coefficient = -0.04, p = 0.013).

Conclusions: Integrating EMA with network analyses can reveal dynamic associations among post-stroke social isolation, health symptoms, and daily activity patterns, pinpointing the potential intervention target. Social isolation was significantly associated with negative feelings (worthlessness and stress), but feeling stressed was followed by being not at home, suggesting adaptive behaviors in people with stroke. These findings align with other literature to suggest out-of-home activity participation to address social isolation and negative affect.

Author(s) Disclosures: Fong has served as a contractor for Isaac Ray Forensic Group and Michigan Avenue Neuropsychologists. Metts and Mohr have an ownership interest in Infinite Arms and Adaptive Health, respectively. Mohr receives royalties from Oxford Press. Hu has a stockholder interest in Tencent Holdings Limited. Co-authors have served as a consultant for Otsuka Pharmaceuticals, Optum Behavioral Health, Centerstone Research Institute, and OneMind Foundation (Mohr); Boehringer Ingelheim, Prodeo, Pritikin, Merck, and IngenioRx (Lenze); Biogen and Regenera (Lee).