Work

Associations between occupational balance and health-related quality of life in informal caregivers of persons after stroke: a cross-sectional study

Year: 2026

Type: article

Abstract: Informal caregivers of persons after stroke frequently experience disruptions in their daily occupations - reduced time and opportunity for self-care, leisure, social participation, and paid work - resulting in restricted occupational balance, that is, lower satisfaction with the amount and variety of everyday activities. Given established links between occupational balance and health, this study examined how caregiver-specific dimensions of occupational balance relate to health-related quality of life (HRQoL) in informal stroke caregivers - an association underexplored in this population. The study also tested whether positive caregiving experience moderates these associations, as positive appraisals may buffer psychological strain - or, conversely, coincide with overcommitment that could exacerbate physical strain. A cross-sectional online survey included 143 informal caregivers of persons after stroke in Austria between August 2023 and April 2025, with regression and moderation analyses based on 138 complete cases. HRQoL was assessed using the 12-Item Short Form Health Survey (SF-12; Physical and Mental Component Summary scores [PCS and MCS]) and occupational balance using the Occupational Balance in Informal Caregivers Questionnaire (OBI-Care; Occupational Areas [OA], Occupational Characteristics [OC], and Occupational Resilience [OR]; higher scores indicate lower balance). Hierarchical ordinary least squares regressions examined associations with PCS and MCS while adjusting for caregiver age, care-recipient age and gender, cohabitation, additional caregiving responsibilities, positive caregiving experience, and caregiver burden. Moderation by positive caregiving experience was tested using PROCESS Model 1. In hierarchical models, greater restriction in occupational balance was associated with lower HRQoL. For PCS, lower balance in OA (β = −0.258, p = .014) and OC (β = −0.299, p = .002) was linked to lower PCS after adjustment; OR was not significant. For MCS, all subscales were associated with lower MCS, strongest for OA (β = −0.571, p < .001), followed by OC (β = −0.376, p < .001) and OR (β = −0.218, p = .009). In moderation analyses, the OC × positive caregiving experience interaction was significant and domain-specific: it strengthened the negative OC-PCS association (b = − 0.64, p = .013) but weakened the OC-MCS association (b = 0.57, p = .025), which became non-significant at higher levels of the moderator. No moderation was found for OA; the OR × positive caregiving experience interaction for MCS was not statistically significant ( p = .083). Fully adjusted hierarchical main-effect models accounted for approximately 12–17% of PCS variance and 29–45% of MCS variance, with the OA–MCS model showing the highest explanatory power (R² = 0.450). Restricted occupational balance was associated with HRQoL, with larger effects for MCS than for PCS. Task-related occupational characteristics were associated with both physical and mental HRQoL. Exploratory interaction analyses suggested different patterns according to positive caregiving experience across the two HRQoL domains, although the MCS interaction was not robust to exclusion of caregiver burden. While causality cannot be inferred, the findings support the relevance of subscale-specific assessment and generate hypotheses for longitudinal and interventional research on occupation-based approaches that expand participation and optimize task demands. Not applicable.

Source: BMC Geriatrics

DOI: 10.1186/s12877-026-08410-w