Fear of Progression and Association Factors in Stroke Patients: A Latent Profile Analysis

Abstract

Background: Fear of progression (FoP) is a prevalent psychological issue among stroke patients. Previous studies failing to distinguish characteristics of patient groups with varying FoP levels. Latent profile analysis (LPA) classifies individuals into distinct subgroups via continuous FoP indicators, boosting classification accuracy by accounting for variable uncertainty. Given FoP's heterogeneity, investigating FoP profiles and their influencing factors in stroke patients is clinically significant for personalized psychological care and improved patient quality of life. Methods: A total of 366 stroke patients were selected as study subjects through convenience sampling, and a cross-sectional survey was conducted. FoP was assessed using the Fear of Progression Questionnaire-Short Form (FoP-Q-SF, 2 dimensions, 12 items). Independent variables included demographic characteristics, clinical indicators, the Recurrence Risk Perception Scale for Stroke patients (RRPSS), and the Medical Coping Modes Questionnaire (MCMQ). LPA was performed on the FoP-Q-SF items to identify subgroups. The R3STEP method was used to analyze influencing factors of subgroup membership, and the BCH method was applied to compare differences in distal outcomes across subgroups. Statistical significance was set at P < 0.05. Results: The study sample had a mean age of 63.93±10.58 years, with 70.5% males and 65.0% first-ever stroke patients. Two latent profiles were identified: Low-FoP Adaptive Type (C1, 48.6%) and High-FoP Sustained Type (C2, 51.4%). The R3STEP showed that age 18-59 years (OR = 0.476, 95%CI = 0.245-0.924, P = 0.028), hypertension comorbidity (OR = 0.402, 95%CI = 0.237-0.683, P = 0.001), higher RRPSS score (OR = 0.971, 95%CI= 0.946-0.995, P = 0.022), MCMQ-confrontation (OR = 0.920, 95%CI = 0.863-0.982, P = 0.011), and MCMQ-avoidance (OR = 0.796, 95%CI = 0.723-0.876, P < 0.001) were significant influencing factors (all P < 0.05). BCH analysis indicated that C2 patients had higher RRPSS score (P < 0.001), higher NIHSS score (P = 0.002) and lower adaptive coping ability than C1. Conclusion: This study revealed significant heterogeneity in FoP among stroke patients. Age, hypertension comorbidity, excessive recurrence risk perception, MCMQ-confrontation, and MCMQ-avoidance were associated with high FoP. Healthcare providers should prioritize identifying high-risk individuals and develop tailored interventions to reduce FoP and improve rehabilitation outcomes.