Quality of life and social support in Jordanian stroke survivors during rehabilitation: The role of mindfulness

Aim: To understand the relationship between social support and quality of life among Jordanian stroke survivors and determine the effect of mindfulness on quality of life among Jordanian stroke survivors throughout rehabilitation.

Background: Stroke as a chronic disease is one of the major global health issues and is the second cause of leading death worldwide. According to disability-adjusted life years, stroke is the third cause of death and disability combined. There are over 12.2 million new cases of stroke each year; Stroke affects one in four people aged over 25, but mainly in people under the age of 70, and each year, 47% of all strokes occur in men and 53% in women. Stroke occurrence is substantial and frequent among the Arab population. It is recommended to monitor and enhance stroke patient QoL, psychological distress, and social support, as much as physical health, as they play a major role in the outcome for stroke patients.

Methods: A pre–post study design was employed to observe stroke survivors throughout their rehabilitation. All participants were recruited from the rehabilitation centre at Al Bashir Hospital in Amman, Jordan, which is one of the largest public hospitals providing multidisciplinary stroke rehabilitation services. A convenience sample of stroke survivors (N = 226; out of 231 initially enrolled) completed the study, with data collected at two distinct time points: the onset of the clinical rehabilitation programme and its completion. This design allowed for the examination of naturally occurring changes during routine clinical care, without introducing any experimental intervention. To assess the key psychosocial variables of interest, social support, QoL, and mindfulness; validated and reliable Arabic versions of three established measures were administered. Social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS), a tool designed to capture perceived support from family, friends, and significant others. QoL was assessed using the Stroke‑Specific Quality of Life Scale (SS‑QOL), which evaluates stroke‑related functional, cognitive, emotional, and social domains. Mindfulness was measured using the Five Facet Mindfulness Questionnaire (FFMQ), which captures multiple dimensions of dispositional mindfulness, including observing, describing, acting 2 with awareness, non‑judging, and non‑reactivity. The use of validated Arabic versions of these instruments ensured cultural and linguistic appropriateness while maintaining strong psychometric standards. Outcome measures were collected at both time points to identify within‑participant changes across the rehabilitation period. A range of statistical analyses were applied, including non‑parametric tests appropriate for non‑normally distributed data, Spearman’s rank‑order correlations to explore associations among variables, and hierarchical multiple regression and mediation analyses to examine predictive relationships and underlying mechanisms. A significance level of α ≤ 0.05 was used to determine statistical significance throughout the analyses.

Results: Social support, QoL, and mindfulness showed statistically significant improvements from T1 to T2 among Jordanian stroke survivors engaged in rehabilitation (p < .001). These findings indicate that, as participants progressed through their routine clinical rehabilitation programme, they experienced meaningful psychosocial and functional gains across all three domains. Positive correlations emerged between social support, QoL, and mindfulness (p < .001), suggesting that individuals who perceived stronger social networks also tended to report higher mindfulness skills and better QoL throughout the rehabilitation period. Importantly, mindfulness contributed unique explanatory power to QoL outcomes at T2, above and beyond the influence of demographic and clinical factors, highlighting its role as an independent psychological resource that may support recovery and adaptation following stroke. Mediation analysis further revealed that mindfulness partially mediated the relationship between social support and QoL, with approximately 50.6% of the total effect being transmitted through mindfulness. This finding suggests that the beneficial impact of social support on QoL operates not only directly, but also indirectly by enhancing individuals’ mindful awareness, emotional regulation, and capacity to respond adaptively to the challenges of recovery. Although several demographic and clinical variables, such as income level, age, and stroke side or severity showed small but statistically significant associations with mindfulness, social support, or particular QoL domains, their effects were modest in comparison to the stronger, consistent pattern linking higher mindfulness and greater perceived social support with superior QoL outcomes. Notably, participants who 3 entered rehabilitation with higher baseline levels of mindfulness exhibited significantly better QoL at programme completion (p < .001), suggesting that early psychological strengths may play a predictive role in shaping subsequent recovery trajectories. Overall, these results highlight the interconnected nature of mindfulness, social support, and QoL in the rehabilitation context and underscore the value of considering psychological and social resources alongside clinical factors when understanding post‑stroke outcomes.

Conclusion: This study identified the role of various factors in stroke-specific QoL among Jordanian stroke survivors in rehabilitation. Mindfulness could have an important role in improving stroke-specific QoL among stroke survivors in rehabilitation and a partial mediation effect in the relationship between social support and QoL. Mindfulness intervention programs may be required to support stroke survivors who suffer from poor QoL during rehabilitation.