Randomized controlled trial of PERMA-based intervention on subjective well-being and post-traumatic growth in young and middle-aged stroke survivors during rehabilitation

Young and middle-aged stroke patients face unique rehabilitation-related psychological distress-such as frustration from slow motor function recovery, anxiety about losing family/social roles, and low motivation for long-term rehabilitation-all of which directly hinder physical recovery and post-stroke adaptation. This study developed a rehabilitation-aligned PERMA (positive emotions, engagement, relationships, meaning, achievement) intervention-rooted in positive psychology and tailored to stroke-specific needs-and evaluated its efficacy in improving subjective well-being (SWB) and post-traumatic growth (PTG) in young and middle-aged stroke patients. A total of 132 eligible patients were randomized into two groups (66 per group) via 1:1 simple randomization, using a computer-generated random number table with allocation concealment via sealed envelopes. The control group received conventional rehabilitation, while the intervention group supplemented with 8 structured PERMA-based sessions over 4 weeks. SWB and PTG were assessed at baseline, post-intervention, 1-month, and 3-month follow-ups. Statistical analyses included independent samples t-tests (between-group comparisons) and repeated-measures ANOVAs (longitudinal changes). SWB scores were significantly higher in the intervention group than in the control group at post-intervention, 1-month, and 3-month follow-ups (t = 2.584, 5.572, 6.099; P < 0.05); PTG scores were also significantly higher at these time points (t = 2.750, 3.948, 5.300; P < 0.01). Repeated-measures ANOVAs confirmed statistically significant time-dependent increases in both outcomes for the intervention group (P < 0.01), with no such significant trend in the control group. The rehabilitation-aligned PERMA intervention effectively enhances SWB and PTG in young and middle-aged stroke patients during recovery. By integrating positive psychology with functional rehabilitation goals, it addresses the unique psychological needs of this population and provides a feasible, clinically applicable support strategy that complements physical rehabilitation.Trial Registration: Registration number of China Clinical Trials Registration Center: ChiCTR2200060103, First Posted date: 18/05/2022, Date of first participant enrollment: 01/12/2022.