Physical dependence, self-efficacy, and resilience in stroke patients: a double-moderated mediation model of healthcare group and pre-stroke employment

AIMS: To examine the concurrent relationships between physical dependence, self-efficacy, and resilience among stroke patients, and to explore whether the healthcare intervention group and pre-stroke employment status jointly moderate this mediated relationship. DESIGN: A cross-sectional study using moderated mediation analysis. METHODS: A total of 123 participants were recruited from a neurology ward in a hospital. Instruments included the Chinese version of the Resilience Scale, the Stroke Self-Efficacy Questionnaire, and the Modified Rankin Scale. Descriptive statistics, correlation analyses, and independent samples t-tests were performed. PROCESS macro (Model 21) with 5,000 bootstrap samples was applied to examine the hypothesized double-moderated mediation model. RESULTS: Self-efficacy mediated the concurrent relationship between physical dependence and resilience. The healthcare intervention group moderated the relationship between physical dependence (operationalized as a binary threshold [mRS ≤ 3 vs. mRS = 4]) and self-efficacy, whereas pre-stroke employment status moderated the relationship between self-efficacy and resilience. Crucially, the conditional indirect pathway was statistically significant exclusively within the routine care group among patients who were unemployed prior to stroke onset. CONCLUSIONS: Greater physical dependence is concurrently associated with lower resilience, a concurrent relationship where lower self-efficacy serves as a partial mediator. This conditional indirect pathway is particularly pronounced among individuals who receive standard routine care and concurrently lack pre-stroke occupational engagement. For patients who were employed before stroke, the concurrent link between self-efficacy and resilience is absent, suggesting that their psychological adaptation is characterized by distinct environmental or vocational factors. IMPLICATIONS FOR PRACTICE AND PATIENT CARE: Routine assessment of physical dependence is crucial for evaluating current functional status and adjusting care plans accordingly. Incorporating social role context and employment history into rehabilitation strategies may further support psychosocial adaptation in stroke patients.