Fear of progression was associated with lower self-care by patients or lower contributions by their spouses in several parts of an analysis of stroke patient-spouse pairs. The study also found that some links between partners' fear scores changed across two sex-coded arrangements: male-patient/female-spouse dyads and female-patient/male-spouse dyads. The findings describe relationships in the data, not a chain of cause and effect.
How the analysis was built
The researchers used a cross-sectional design, meaning they measured the participants at one point rather than following changes over time. They recruited 384 stroke patient-spouse caregiver dyads purposively from one tertiary hospital between August 2024 and March 2025. Four questionnaires covered fear of progression in patients and spouses, the patient's self-care, and the spouse's contribution to that self-care.
To examine how these measures fitted together, the researchers used a moderated network model. In this approach, each questionnaire dimension is treated as a node and a reported edge represents an association between two nodes after the model's selection and fitting steps. A positive edge indicates that the two scores were higher together in the sample; it does not mean one produced the other.
Links appeared on both sides of the relationship
Several positive links crossed the patient-spouse boundary. Patient physical-health fear of progression was linked with spouse family-health fear at 0.12, while patient social-family fear was linked with spouse family-health fear at 0.15. A reported positive self-care link connected patient maintenance with the spouse's contribution to maintenance at 0.19; matching monitoring and management links were 0.12 and 0.14.
The inverse links were spread across both partners' measures. Patient physical-health fear was associated with a lower spouse maintenance contribution, with a reported edge weight of -0.14. Patient social-family fear was associated with patient management at -0.12 and spouse monitoring contribution at -0.17. Spouse family-health fear was associated with spouse management contribution at -0.17, and spouse social-function fear with patient management at -0.11. These are associations between questionnaire dimensions, so they cannot show whether fear reduced self-care, poor self-care increased fear, or another direction was involved.
The pattern varied by dyad group
Sex also moderated two cross-partner fear-of-progression associations. The reported 95% confidence intervals for the interactions ran from 0.210 to 0.442 and from 0.405 to 1.054, intervals that excluded zero. The supplied analysis reports group-specific estimates as negative for group 0, male-patient/female-spouse dyads, and positive for group 1, female-patient/male-spouse dyads. In ordinary terms, the estimated relationship between the partners' fear dimensions changed with the sex-coded arrangement of the pair.
Four further interaction results examined spouse fear of progression against self-care contributions. The reported intervals were 0.129 to 0.534, 0.153 to 0.412, 0.154 to 0.463 and 0.228 to 0.469. The effects were negative in both groups and were stronger in the female-spouse group, according to the analysis. That result points to a difference in association strength, not proof that one group's fear caused poorer care.
What the results can and cannot say
Patient self-care maintenance had the highest expected influence in the network, with a reported value of 1.692. Stability checks produced coefficients of 0.75 and 0.28 for pairwise and interaction estimates, and 0.67 and 0.36 for expected influence. All were above the study's stated acceptable threshold of 0.25, although stability does not turn a cross-sectional association into a causal finding.
The study's scope remains narrow. All 384 dyads came from one hospital, and the authors say that single-site recruitment may limit how well the pattern applies elsewhere. Because the design was cross-sectional, it cannot establish temporal or causal direction. The authors call for multicenter and longitudinal studies to test whether the same network appears in other settings and over time.
Paper data and sources
Original title: Association Between Fear of Progression and Dyadic Self-Care in Patients With Stroke and Their Spouses: A Moderated Network Analysis.
Authors: Luyi Xu, Tingting Lin, Zheng Wang et al.
Journal/Repository: The journal of nursing research : JNR
Status: Peer-reviewed
First online: 2026-10-01
DOI: 10.1097/jnr.0000000000000770
Original paper · Full text