Adaptation Following Stroke: A Personal Projects Analysis

Objectives: Assessment of adaptation following stroke has tended to focus either on acceptance of disability or global indicators of well-being. People with stroke, however, tend to view adaptation in terms of reengagement with personally valued activities. We model the adaptation process by assessing change in importance, control, stress, challenge, pleasure, support and self-identification of personal projects (i.e., one's current activities such as work, leisure, and recreational activities) from prestroke to 24 months poststroke. Method: Personal projects, general health, and general well-being were assessed via interviews with a sample of 67 community-residing stroke survivors (39 male; mean age = 64.7 years, SD = 13.2) on five occasions over the first 24 months poststroke. Results: Multilevel (hierarchical) modeling of the longitudinal data indicates that project dimensions of Control, Stress, Challenge, Pleasure, and Support predict well-being in expected ways. Although projects at 6 months poststroke were rated as more important, stressful, challenging, and supported by others and less controllable and pleasurable than prestroke projects, by 12 to 18 months all project ratings had returned to prestroke levels, thereby suggesting successful adaptation. Conclusions/Implications: Longitudinal analysis of survivors' participation in valued activities poststroke revealed a pattern of adaptation that relates to but goes beyond that suggested by global measures of health, functioning, and well-being. The focus on adaptation of personal projects or valued activities may provide a helpful way of examining and improving well-being poststroke and offer new insights to inform the development of effective interventions for improving well-being following stroke.