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Psychophysiological effects of an expressive arts-based intervention in young and pre-elderly stroke survivors: A randomized controlled trial
Date Issued
2025
Publisher
Elsevier BV
ISSN
0003-9993
1532-821X
Citation
Archives of Physical Medicine and Rehabilitation, 2025, vol. 106(9), pp. 1303-1311.
Type
Peer Reviewed Journal Article
Abstract
Objective
To examine the psychophysiological effects of an 8-week expressive arts-based intervention (EABI) on young and pre-elderly stroke survivors.
Design
A parallel-group randomized controlled trial.
Setting
Public hospitals and community sites.
Participants
Community-dwelling participants (N=157) aged between 18 and 64 years who experienced a major stroke event in the past 10 years with mild to moderate post-stroke impairments (modified Rankin scale level=1-4).
Interventions
Participants were randomly assigned to an 8-week EABI group (N=75) once per week for 90 minutes or a treatment-as-usual waitlist control group (CG) (N=82). Main Outcome Measures
Outcomes of psychophysiological functioning, including depression, anxiety, perceived social support, hope, self-esteem, generic and stroke-specific quality of life (QOL), and salivary cortisol, were measured at three assessment waves: baseline (T0), 2 months after baseline (T1), and 8 months after baseline (T2). The short-term (T0-T1) and long-term (T0-T2) effects of the EABI were analyzed by latent change analysis. Mediation analysis was conducted to explore the potential mechanisms of the short-term and long-term EABI effects.
Results
From T0 to T1, the EABI group showed significant improvements in perceived social support, hope, and self-esteem (Cohen d=0.32-0.48) compared with the CG. From T0 to T2, there were significant improvements in anxiety symptoms and self-esteem, physical QOLs, and wake-up cortisol (d=0.34-0.46). Short-term improvements in perceived social support and hope partially mediated the long-term EABI effects on physical QOLs. The beneficial effects of EABI showed heterogeneity across gender and stroke types.
Conclusions
This study found short-term effects for the EABI on perceived social support and hope and long-term effects on self-esteem and physiological functioning. Future research should develop tailored EABI as multifaceted support for rehabilitation practice for stroke survivors.
To examine the psychophysiological effects of an 8-week expressive arts-based intervention (EABI) on young and pre-elderly stroke survivors.
Design
A parallel-group randomized controlled trial.
Setting
Public hospitals and community sites.
Participants
Community-dwelling participants (N=157) aged between 18 and 64 years who experienced a major stroke event in the past 10 years with mild to moderate post-stroke impairments (modified Rankin scale level=1-4).
Interventions
Participants were randomly assigned to an 8-week EABI group (N=75) once per week for 90 minutes or a treatment-as-usual waitlist control group (CG) (N=82). Main Outcome Measures
Outcomes of psychophysiological functioning, including depression, anxiety, perceived social support, hope, self-esteem, generic and stroke-specific quality of life (QOL), and salivary cortisol, were measured at three assessment waves: baseline (T0), 2 months after baseline (T1), and 8 months after baseline (T2). The short-term (T0-T1) and long-term (T0-T2) effects of the EABI were analyzed by latent change analysis. Mediation analysis was conducted to explore the potential mechanisms of the short-term and long-term EABI effects.
Results
From T0 to T1, the EABI group showed significant improvements in perceived social support, hope, and self-esteem (Cohen d=0.32-0.48) compared with the CG. From T0 to T2, there were significant improvements in anxiety symptoms and self-esteem, physical QOLs, and wake-up cortisol (d=0.34-0.46). Short-term improvements in perceived social support and hope partially mediated the long-term EABI effects on physical QOLs. The beneficial effects of EABI showed heterogeneity across gender and stroke types.
Conclusions
This study found short-term effects for the EABI on perceived social support and hope and long-term effects on self-esteem and physiological functioning. Future research should develop tailored EABI as multifaceted support for rehabilitation practice for stroke survivors.
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