Live well after stroke: Methods of a community-based, occupational therapist–led, life management intervention

Abstract

Stroke is one of the leading causes of disability across the world. Post-stroke disability results in physical, cognitive, and emotional deficits leading to activity limitations and participation restrictions for individuals with stroke. Suffering a second stroke further compounds the devastating impact of stroke related disability. Lifestyle programs have shown effectiveness in preventing stroke; however, few individuals with stroke are able to participate in such programs, especially if they are from disadvantaged populations. The purpose of this study was to develop a comprehensive and intensive life management intervention for stroke survivors from racially/ethnically diverse, underrepresented populations by inculcating sustainable health-promoting behaviors, improving health-related quality of life, and mitigating recurrent stroke risk factors. Design: Formative Evaluation: Interviews. Setting: Safety-net rehabilitation hospital and participants’ homes and community. Participants: Ten ethnically/racially diverse patients from underrepresented backgrounds from a rehabilitation center in an urban metropolis Intervention: 6-month life management intervention with one-on-one sessions with an occupational therapist in the participants’ home and monthly group sessions in the community. Intervention focused on changing lifestyle habits to reduce secondary stroke risk factors and improving health-related quality of life through knowledge acquisition, self-management skill practice, self-efficacy/confidence to change, motivation to change, and habit formation. Main Outcome Measures: Interview narratives and content and narrative from session notes. Based on the information gleamed from the narratives, the intervention was revised in the following areas: manual outline and content, foundational components, and treatment theory structure revisions (active ingredients, mechanisms of change, target outcomes). Based on the findings of the feasibility study narratives, the life management intervention was revised to capture more effective methods and content to assist individuals with stroke to make healthy lifestyle habit changes, mitigating secondary stroke risk factors and improving health-related quality of life. The program was feasible to administer in a US safety-net healthcare system.