Economic toxicity and quality of life in stroke patients: a moderated mediation model of self-management and family function

To investigate the relationships among economic toxicity, family function, self-management ability, and stroke-specific quality of life in stroke patients during the rehabilitation period, and to construct and test a moderated mediation model with self-management as the mediator and family function as the moderator, so as to provide empirical evidence for improving the quality of life of stroke patients. A cross-sectional survey was conducted from May to June 2025 across 22 medical and elderly care institutions in Chongqing, China. A total of 557 stroke patients in the rehabilitation period completed questionnaires measuring sociodemographics, economic toxicity (COST-PROM), family function (Family APGAR Scale), self-management (Stroke Self-Management Scale), and stroke-specific QoL (SS-QOL Scale). The moderated mediation model was tested using the PROCESS macro in SAS 9.4. Economic toxicity was significantly negatively correlated with quality of life ( r = -0.424, P < 0.001); self-management played a partial mediating role between economic toxicity and quality of life, with the mediating effect accounting for 50.56%; family function played a significant buffering moderating role between economic toxicity and self-management ( β = 0.209, P < 0.001), and high family function could significantly weaken the negative impact of economic toxicity on self-management. Economic toxicity impairs QoL both directly and indirectly through reduced self-management. Strong family function buffers the detrimental effect of economic toxicity on self-management. Interventions targeting economic toxicity screening, self-management support, and family empowerment may help improve QoL in stroke survivors and warrant prospective evaluation.