The role of social support in the recovery of stroke survivors has been a subject of considerable interest. It has been hypothesized that social support may positively influence functional outcomes through various mechanisms, including enhanced adherence to rehabilitation programs, reduced psychological stress, and improved overall well-being . However, establishing a clear causal link between social support and functional recovery in stroke patients is challenging due to the presence of numerous confounding factors that can influence both the level of social support received and the extent of functional improvement. This study aimed to investigate the causal effect of high social support on functional outcomes in stroke rehabilitation patients, utilizing advanced causal inference methods applied to a large synthetic healthcare dataset. The synthetic data, generated to mirror real-world patterns while preserving patient privacy, allowed for a rigorous analysis that addressed potential confounding. The key finding of this analysis was that, after adjusting for a comprehensive set of confounders, including depression, high social support showed no significant causal effect on functional outcomes 12 months post-stroke. This result contrasts with initial unadjusted analyses that indicated a significant positive association, highlighting the critical importance of accounting for confounding in observational studies. The emergence of depression as a key confounder suggests that psychological factors may play a more significant role in rehabilitation outcomes than social support alone. These findings have important implications for the design of interventions aimed at improving functional recovery after stroke, suggesting that a focus on addressing psychological well-being alongside social support may be more effective.

The authors have declared no competing interest.

This study was partially funded by University of Calgary OpenDH program and Alberta Ministry of Mental Health

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study used (or will use) ONLY openly available human data that were originally located at Synthetic Data Vault which is an open-source ecosystem born in MIT Data to AI Lab

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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All data produced in the present study are available upon reasonable request to the authors