Abstract
BackgroundElectronic communication is used in various populations to achieve health goals, but evidence in stroke is lacking. We pilot tested the feasibility and potential effectiveness of a novel personalised electronic self-management intervention to support person-centred goal attainment and secondary prevention after stroke.MethodsA phase I, prospective, randomised controlled pilot trial (1:1 allocation) with assessor blinding, intention-to-treat analysis, and a process evaluation. Community-based survivors of stroke were recruited from participants in the Australian Stroke Clinical Registry (AuSCR) who had indicated their willingness to be contacted for research studies. Inclusion criteria include 1–2 years following hospital admission for stroke and living within 50 km of Monash University (Melbourne). Person-centred goals were set with facilitation by a clinician using a standardised template. The intervention group received electronic support messages aligned to their goals over 4 weeks. The control group received only 2–3 electronic administrative messages. Primary outcomes were study retention, goal attainment (assessed using Goal Attainment Scaling method) and satisfaction. Secondary outcomes were self-management (Health Education Impact Questionnaire: 8 domains), quality of life, mood and acceptability.ResultsOf 340 invitations sent from AuSCR, 73 responded, 68 were eligible and 57 (84%) completed the baseline assessment. At the goal-setting stage, 54/68 (79%) were randomised (median 16 months after stroke): 25 to intervention (median age 69 years; 40% female) and 29 to control (median age 68 years; 38% female). Forty-five (83%) participants completed the outcome follow-up assessment. At follow-up, goal attainment (mean GAS-T score ≥ 50) in the intervention group was achieved for goals related to function, participation and environment (control: environment only). Most intervention participants provided positive feedback and reported that the iVERVE messages were easy to understand (92%) and assisted them in achieving their goals (77%). We found preliminary evidence of non-significant improvements between the groups for most self-management domains (e.g. social integration and support: β coefficient 0.34; 95% CI − 0.14 to 0.83) and several quality-of-life domains in favour of the intervention group.ConclusionThese findings support the need for further randomised effectiveness trials of the iVERVE program to be tested in people with new stroke.Trial registrationANZCTR, ACTRN12618001519246. Registered on 11 September 2018—retrospectively registered.
Highlights
Electronic communication is used in various populations to achieve health goals, but evidence in stroke is lacking
Of 340 invitations sent from Australian Stroke Clinical Registry (AuSCR), 73 responded, 68 were eligible and 57 (84%) completed the baseline assessment
At follow-up, goal attainment in the intervention group was achieved for goals related to function, participation and environment
Summary
Electronic communication is used in various populations to achieve health goals, but evidence in stroke is lacking. The presence of physical disability, loss of employment, inability to participate in pre-stroke activities, social isolation, anxiety [2] and depression [3] make returning to the community difficult [4]. This can be further complicated by the need to manage the risk factors that caused the stroke to avoid further vascular events. These ongoing physical, physiological and psychosocial impacts are associated with unplanned readmission, reduced participation and quality of life, and unmet needs across a range of domains [5, 6]. One approach to enhancing self-efficacy in people living with stroke is through self-management programs [7]
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