Table_2_In Search for the Meaning of Illness: Content of Narrative Discourse Is Related to Cognitive Deficits in Stroke Patients.DOCX

Stroke survivors undergo a thorough cognitive diagnosis that often involves administration of multiple standardized tests. However, patient’s narrative discourse can provide clinicians with additional knowledge on patient’s subjective experience of illness, attitude toward current situation, and motivation for treatment. We evaluated the methods of analyzing thematic content and story types in relationship to cognitive impairment in stroke survivors with no aphasia (including 9 left hemisphere damage – LHD patients, and 16 right hemisphere damage – RHD patients). Cognitive impairment was evaluated in comparison to a group of 25 patients with orthopaedic injury not involving the brain. Our findings primarily show that higher elaboration on own cognitive problems, physical ailments or coping strategies in LHD patients and cognitive problems, emotional issues and circumstances of illness onset in RHD patients is related to deficits in executive functions and retrieval of information from memory. Furthermore, RHD patients who use more chaos story type show lower executive functioning. However, these results did not survive the significance threshold of p < 0.05 after Bonferroni adjustment for multiple comparisons. In conclusion, this study provides preliminary evidence that stroke survivor’s narrative can constitute an additional source of clinically-relevant information regarding patient’s experience of illness and attitude toward recovery. This knowledge can aid clinicians and nurses in everyday interactions with the patients and support individualized strategy to treatment. Still, the current results need be confirmed with future studies in a larger cohort of stroke patients.

卒中幸存者在经历一系列详尽的认知诊断过程中，通常包括多项标准化测试的实施。然而，患者的叙事性话语能够为临床医生提供关于患者疾病主观体验、对当前状况的态度以及治疗动机的额外知识。本研究评估了分析主题内容和故事类型的方法，以探讨其在无失语症的卒中幸存者认知障碍（包括9例左侧大脑半球损伤——LHD患者和16例右侧大脑半球损伤——RHD患者）中的关系。我们将认知障碍的评估与25名无脑部损伤的骨科损伤患者进行比较。研究的主要发现表明，在LHD患者中，对自身认知问题、身体不适或应对策略的更高阐述，以及在RHD患者中，对认知问题、情绪问题和疾病发病情形的更高阐述，与执行功能和从记忆中检索信息的能力缺陷相关。此外，采用更多混沌故事类型的RHD患者表现出较低的执行功能。然而，在经过多重比较的Bonferroni校正后，这些结果未能达到p < 0.05的显著性阈值。综上所述，本研究初步证实，卒中幸存者的叙事可以构成关于患者疾病体验和对康复态度的临床相关信息的额外来源。此类知识有助于临床医生和护士在日常与患者的互动中提供支持，并支持个体化的治疗策略。尽管如此，当前的结果需要通过更大规模卒中患者队列的后续研究进行证实。