title: 'Insistence on recovery' as a positive prognostic factor in Japanese stroke patients.
abstract: OBJECTIVE
  The present study used two-step analyses to examine the effect of acceptance of disability or 'insistence on recovery' in Japanese stroke patients: first on their functional improvement and second, on their psychological symptoms.
  
  
  METHODS
  Disability was assessed using functional independence measurements (FIM), examining the stage of acceptance of disability by observation using Fink's theory (from shock to defensive retreat, acknowledgement, and acceptance/change stage), and estimation of insistence on recovery (on a scale of 1-4) by observation. The differences over time and the effects on the improvement in their FIM were then assessed. Depression was measured using the Zung Self-rating Depression Scale (SDS); apathy was measured using the Apathy Scale (AS), and the correlation with the acceptance stage or insistence on recovery was analyzed.
  
  
  RESULTS
  The acceptance stage and functional improvement progressed significantly, but insistence on recovery did not change significantly during hospitalization. Multiple regression indicated that the insistence on recovery score (but not the acceptance stage) was a good predictor of the degree of improvement in FIM (FIM gain per week) in the elderly group. Post-hoc testing showed that the SDS or AS score decreased from the first stage to the fourth stage (but increased at the third stage) of acceptance; whereas for insistence on recovery score, the SDS and AS scores decreased as insistence on recovery score changed from 1 to 3, and then increased as insistence on recovery score changed from 3 to 4.
  
  
  CONCLUSIONS
  The appropriate level of insistence on recovery reduced depression and apathy, resulting in enhanced improvement of disability after a stroke in elderly stroke patients.
authors.affiliation: Department of Rehabilitation, Nishi-Hiroshima Rehabilitation Hospital, Hiroshima, Japan. shama@hiroshima-u.ac.jp
authors.forename: Seiji
authors.initials: S
authors.lastname: Hama
authors.forename: Hidehisa
authors.initials: H
authors.lastname: Yamashita
authors.forename: Toyohiko
authors.initials: T
authors.lastname: Kato
authors.forename: Masaya
authors.initials: M
authors.lastname: Shigenobu
authors.forename: Atsuko
authors.initials: A
authors.lastname: Watanabe
authors.forename: Megumi
authors.initials: M
authors.lastname: Sawa
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kurisu
authors.forename: Shigeto
authors.initials: S
authors.lastname: Yamawaki
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kitaoka
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003469:Culture; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055809:Illness Behavior; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010555:Personality Inventory; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation