Efficacy of a Novel Nurse-Led PERMA Model Intervention on Psychological Well-being and Rehabilitation Adherence in Stroke Survivors: A Randomized Controlled Trial
BackgroundPoor adherence to rehabilitation is a major challenge in stroke recovery, closely linked to psychological factors such as diminished well-being. Although nurses are ideally positioned to provide psychosocial support, the absence of structured, evidence-based frameworks constitutes a critical barrier, resulting in a significant psychological-care gap. The PERMA model from positive psychology offers a promising structured framework to address this gap.MethodsThis was a single-blind, randomized controlled trial involving 80 patients with ischemic stroke, allocated to an experimental (n=40) or control (n=40) group. The experimental group received an 8-week, nurse-led intervention grounded in the PERMA model, comprising twice-weekly, 30-minute sessions plus usual care. The control group received standard care matched in frequency. Primary outcomes were subjective well-being (IWB) and rehabilitation adherence (EAQ); secondary outcomes included depressive symptoms (HADS-D) and neurological function (mRS). Assessments occurred at baseline, post-intervention (week 8), and 15-week follow-up. Data were analyzed using Generalized Estimating Equations (GEE) based on the intention-to-treat principle.ResultsSignificant group-by-time interactions were observed for subjective well-being (F=5.53, P=0.005) and rehabilitation adherence (F=3.98, P=0.025). At post-intervention, the experimental group showed significantly greater improvements in subjective well-being (9.27±1.01 vs. 8.08±0.96, mean difference [MD]=1.19, P<0.01) and rehabilitation adherence (34.96±4.56 vs. 31.85±4.67, MD=3.11, P<0.01), along with a greater reduction in depressive symptoms (7.08±3.22 vs. 8.85±3.02, MD=-1.77, P<0.05). The improvement in subjective well-being was sustained at follow-up (9.45±1.32 vs. 8.56±0.92, MD=0.89, P<0.05), whereas the between-group difference in adherence was not maintained. No significant differences were found in anxiety symptoms or neurological function.ConclusionThis study provides evidence for the efficacy of a structured, nurse-led positive psychology intervention, offering an operational toolkit to bridge the psychological-care gap in stroke rehabilitation. The findings justify the formal integration of these strategies into standard rehabilitation protocols and highlight the need for policy changes that recognize and support the expanded role of nurses in multidisciplinary teams.