Standardization of Connor-Davidson Resilience Scale in Iranian subjects with Cerebrovascular Accident

Background: Resilience is a personal trait that can influence the stroke subjects’ attitudes toward future opportunities and facilitate the transitional process and adaptation in them. Assessment of this trait in stroke subjects with a standardized tool would promote the rehabilitation protocols and occupational therapy interventions. Therefore, the objective of this study was to standardize the Connor-Davidson Resilience Scale (CD-RISC) for Persian Iranian people who have had strokes. Methods: A descriptive observational study was adopted in order to standardize the CD-RISC in stroke population. The population was comprised of 34 female and 29 male subjects with a mean age of 51.4±10.6 years and the history of ischemic or hemorrhagic cerebrovascular accidents. Subjects were recruited based on inclusion criteria within the period of two months between May and July of 2014. Descriptive statistics were calculated along with the Cronbach’s alpha to determine reliability. Standard multiple regression analyses searched for any correlation between variables and resilience. Results: Statistical parameters revealed a mean of 58.4±15.5 for CD-RISC raw scores. Percentile ranks were also calculated from raw data. Cronbach’s alpha of 0.892 revealed that the CD-RISC had high reliability for the population of this study. Multiple regression analyses showed that the functional status was the only variable that uniquely predicted subjects’ resilience (ß=0.41; P<0.01). Conclusion: The findings of this research confirmed applicability of CDRISC in Iranian people who have had strokes. The standardized CD-RISC was determined to be suitable for use in the clinic and for utilization in research studies in Iranian people status post-stroke. 2014© The Authors. Published by JRSR. All rights reserved. *Corresponding author: Seyed Alireza Derakhshanrad, Department of Occupational Therapy, School of Rehabilitation Sciences, Abiverdi St., Chamran Blvd., Shiraz, Iran, Tel: +98-71-36271551, E-mail: [email protected] Introduction Cerebrovascular accident (CVA), commonly called stroke is a condition in which blood flow to cerebral vessels becomes disrupted, due to reasons such as clot or rupture that subsequently disrupts blood supply to brain tissue and causes deficits in the function of this organ [1]. It is one of the leading cause of mortality and morbidity worldwide [2]. There is a lack of comprehensive epidemiologic studies to show the prevalence and Journal of Rehabilitation Sciences and Research Journal Home Page: jrsr.sums.ac.ir Derakhshanrad SAR et al. JRSR. 2014;1(4) 74 incidence rate of stroke in Iran, because the existing studies were collected in regional areas of Iran. One systematic review article analyzed incidence rate of stroke in various parts of Iran and reported a wide range of 23 to 104 per 100000, of which the case fatality rate was 19% to 32% at the first month after stroke [3]. With advances in medical care, a large percentage of people with stroke survive as the chronically disabled [4]. These chronically ill survivors suffer from various limitations in occupational tasks including self-care, household work, and social activities [5]. It has been shown that attitude of stroke subjects towards their ability to exert control in the resulting situation in life determines the degree of improvement and return to life’s routine [6]. In this situation, the positive and constructive attitude can facilitate the transitional process so that the individuals can adapt and cope with the new situation that effects their ability to return to function in daily activities [7]. Generally, people with chronic illnesses must learn coping skills and apply them to meet their daily challenges. Resilience is the successful adjustment to challenging situations in life, such as the ability and skill to adapt to an acute or chronic condition [8]. Resilience facilitates the transitional process and the learning of adaptive methods in subjects with chronic diseases [9]. It is important for occupational therapists to appreciate resilience as a valuable personal trait that can influence attitude and positive adaptation to the conditions following stroke. Therefore, identification of resilience traits in clients and importance to the adaptation response will promote development of protocols and interventions to foster resilience in people that have little of this beneficial trait [10-11]. Within the cognitive domain including decision making, creativity, problem-solving, planning, and selfesteem, represent the skills that are directly related to the quality of the resilience [12]. Therefore focus on these cognitive capacities in rehabilitation protocols might lead to fostering resilience in stroke subjects [10]. Assessment is fundamental to design an appropriate treatment plan that considers the development of occupational activities to facilitate resilience. The assessment of resilience leads to identification of strengths and weaknesses [13], which can contribute an integral part of evaluation of clients to obtain the whole picture of occupational performance. The Connor-Davidson Resilience Scale (CD-RISC) was devised as a simple, practical self-rating scale to rate and quantify characteristics of the resilience trait [14]. The scale has 25 items, each of which is scored from 0-4. Respondents rate items on a scale from absolutely false (0) to always true (4). The full range is from 0 to 100, with greater scores reflecting higher resilience. The inventors of CD-RISC [14] summarized 17 most notable characteristics of resilient people, some of which include: “View change or stress as a challenge/opportunity”, “Recognition of limits to control”, “Personal or collective goals”, “Strengthening effect of stress”, “Realistic sense of control/having choices”, “Action-oriented approach”, “Tolerance of negative affect”, and “Adaptability to change” (p.77). The CD-RISC has been of great interest among Iranian researchers and practitioners. The feasibility of the scale has been verified in several Iranian studies in different population for use with people with substance dependency [15], chronic pain [16], and spinal cord injury [17]. As the CD-RISC was not intended for just one specific population, the creators supported expansions of the tool by other researchers [18]. The CD-RISC has not been reported in the literature to have been standardized for people who were status poststrokes, in any country thus far. Therefore, in order to conduct a study of people who demonstrate resilience behaviors following strokes, it was necessary to obtain standardization values for this instrument on the population to be studied. Then, the specific aim of this study was to provide a standardized test of CD-RISC for Persian Iranian people who have had strokes for use in the clinic and for utilization in research studies.