Associations between dyadic spirituality, caregiver burden, disability, and health-related quality of life in stroke survivor–caregiver dyads: a dyadic structural equation modelling study

AIMS: This study examined the associations between spirituality, caregiver burden, disability, and health-related quality of life (HRQoL) within stroke survivor-caregiver dyads using a dyadic structural equation modelling (SEM) approach. The aim was to explore spirituality as a shared dyadic resource in post-stroke adaptation. METHODS AND RESULTS: A cross-sectional analysis was conducted with 217 stroke survivor-caregiver dyads recruited at discharge from rehabilitation hospitals. Spirituality, caregiver burden, disability, and HRQoL were assessed using validated instruments. Dyadic SEM estimated within-person and cross-dyadic associations. Missing data were minimal and not systematic. Survivors' spirituality showed significant within-person associations with better physical (β = 0.304, P < 0.001), cognitive (β = 0.449, P < 0.001), emotional (β = 0.455, P < 0.001), and social HRQoL (β = 0.343, P < 0.001). Cross-dyadic associations were observed: higher survivor spirituality was associated with lower caregiver time-dependent (β = -0.275, P < 0.001), developmental (β = -0.208, P < 0.001), and physical burden (β = -0.183, P = 0.030). Caregivers' spirituality showed a non-significant trend towards lower survivor cognitive disability (β = -0.117, P = 0.052). After adjustment for caregiver gender and survivors' activities of daily living, caregiver spirituality was associated with lower developmental burden (β = -0.227, P = 0.023). CONCLUSION: Spirituality was associated with multiple dimensions of post-stroke adaptation through distinct within- and cross-dyadic pathways. These findings support the relevance of dyadic SEM in stroke rehabilitation and highlight spirituality as a relational psychosocial resource within survivor-caregiver dyads.