Longitudinal study of Dyadic Self-Care in Stroke Patients and Caregivers: A Group-Based Multi-Trajectory Analysis

Background: Promoting self-care is widely recommended as an effective approach to reducing the burden of stroke. As a dyadic process, it involves the active participation of both patients and caregivers. However, its complexity and long-term nature are still not well understood. Objective: To investigate the developmental trajectories of dyadic self-care in stroke patients and caregivers, elucidate distinct trajectory patterns and their influencing factors. Design: A longitudinal multi-center study was conducted. Settings: Outpatient and community settings in China. Methods: A total of 214 stroke patient–caregiver dyads completed data collection at four time points: 1 month (T0), 3 months (T1), 6 months (T2), and 12 months (T3) following discharge after a first-ever stroke. Group-based multi-trajectory modeling was employed to identify the heterogeneity of the trajectories of the dyadic self-care maintenance, monitoring, and management among stroke patients and caregivers. Multiple logistic regression was used to explore the predictors of heterogeneous trajectories of dyadic self-care. Results: Four distinct trajectories of dyadic self-care maintenance were identified in stroke dyads: "Dyadic Middle-Low Decrease" (29.49%), "Patient Middle-Low Decrease and Caregiver Middle-High Decrease" (28.67%), "Patient Middle-High Decrease and Caregiver Middle-Low Decrease" (18.07%), and "Dyadic Middle-High Sustained" (23.77%). For dyadic self-care monitoring, the trajectories included: "Dyadic Middle-Low Decrease" (25.05%), "Patient Middle-Low Decrease and Caregiver Middle-High Decrease" (30.93%), "Patient Middle-High Decrease and Caregiver Middle-Low Decrease" (19.11%), and "Dyadic Middle-High Decrease" (24.91%). Dyadic self-care management trajectories comprised: "Dyadic Middle-Low Increase" (27.49%), "Patient Middle-Low Increase and Caregiver Middle-High Sustained" (25.43%), "Patient Middle-High Increase and Caregiver Middle-Low Decrease" (18.77%), and "Patient Middle-High Increase and Caregiver Middle-High Sustained" (28.31%). Multiple logistic regression analysis identified several significant predictors of dyadic self-care trajectories, including patients’ self-efficacy, mutuality, knowledge, stroke environment, use of electronic devices, employment and education status, as well as caregivers’ self-efficacy, mutuality, caregiving hours, relationship with the patient, knowledge, and employment status. Conclusions and Implications: The developmental trajectory of dyadic self-care for stroke patients and caregivers exhibits heterogeneity, suggesting that future research should integrate the longitudinal changes in dyadic self-care characteristics of patients and caregivers and trajectory classification, focusing on its influencing factors for precise classification and intervention. Registration: Clinical trial number: not applicable.