Aim: We designed two-step analyses to examine the effect of acceptance of disability or "insist on recovery" in Japanese stroke patients: firstly on their functional improvement and secondly on their psychological symptoms.

Methods: We assessed disability using functional independence measurements (FIM), examined the stage of acceptance of disability by observation using Fink's theory (from shock to defensive retreat, acknowledgement, and acceptance/change stage), and quantitatively estimated "insist on recovery" (on a scale from 1 to 4) by observation. We then assessed the differences over time and the effects on the improvement in their FIM. We assessed depression using the Zung Self-rating Depression Scale (SDS); apathy using the Apathy Scale (AS), and assessed the correlation with the acceptance stage or "insist on recovery."

Results: The acceptance stage and functional improvement progressed significantly, but "insist on recovery" did not change significantly during hospitalization. Multiple regression analysis revealed that the "insist on recovery" score (but not the acceptance stage) was a good predictor of the degree of improvement in FIM (FIM gain per week) in the elderly group. Post-hoc testing showed that the SDS or AS score decreased from the 1st stage to the 4th stage (but increase at the 3rd stage) of acceptance, the score decreasing from 1 to 3; however the score for "insist on recovery" increased from 3 to 4.

Conclusions: The appropriate level of "insist on recovery" reduced depression and apathy, resulting in enhanced improvement of disability after a stroke in elderly stroke patients.