Ho, Rainbow T. H.Rainbow T. H.HoLo, Temmy L.T.Temmy L.T.LoFong, Ted C. T.Ted C. T.FongDr. CHAN Kar-pui, CaitlinCaitlinDr. CHAN Kar-puiPang, Marco Y. C.Marco Y. C.PangWan, Adrian H. Y.Adrian H. Y.WanLau, Gary K.K.Gary K.K.LauLeung, Pamela P. Y.Pamela P. Y.Leung2026-06-222026-06-222025Archives of Physical Medicine and Rehabilitation, 2025, vol. 106(9), pp. 1303-1311.0003-99931532-821Xhttp://hdl.handle.net/20.500.11861/27612Objective<br> To examine the psychophysiological effects of an 8-week expressive arts-based intervention (EABI) on young and pre-elderly stroke survivors.<br> Design<br> A parallel-group randomized controlled trial.<br> Setting<br> Public hospitals and community sites.<br> Participants<br> 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).<br> Interventions<br> 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<br> 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.<br> Results<br> 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.<br> Conclusions<br> 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.enPeer Reviewed Journal Article10.1016/j.apmr.2025.04.008