Abstract
BackgroundRecovery after stroke is long-term and demanding. Optimising community-residing stroke survivors’ capability to self-manage their health is integral. Recent systematic reviews have shown that stroke self-management programmes were associated with significant improvement in stroke survivors’ health-related quality of life and self-efficacy. However some programmes were not designed with an underpinning theoretical framework. The aim of this study is to compare the effectiveness of a nurse-led stroke self-management programme with usual care on recovery of community-residing stroke survivors.Methods/DesignA single-blinded, two-arm, randomised controlled trial will be conducted. Patients with a history of first or recurrent ischaemic or haemorrhagic stroke who will be discharged to home settings will be recruited from acute stroke units of three acute public hospitals in Hong Kong. The estimated sample size is 160 (80 participants per group). Eligible participants will be randomised to receive either usual care or a 4-week nurse-led community-based self-management programme plus usual care after discharge. The programme, underpinned by Bandura’s constructs of self-efficacy and outcome expectation, includes one individual home visit, two community-based group sessions, and three follow-up phone calls. Primary outcomes include stroke survivors’ self-efficacy and outcome expectation of performing self-management behaviours. Secondary outcomes include health-related quality of life, satisfaction with performance of self-management behaviours, depressive symptoms, and community reintegration. Participants will be assessed at baseline and at 8 weeks after randomisation. Generalised estimating equations will be performed to evaluate the significance of changes in outcomes over time by treatment condition. Research ethics approvals were obtained.DiscussionIt is expected that stroke survivors receiving the stroke self-management programme will have improved self-efficacy, outcome expectation, and performance of stroke self-management behaviours. Enhanced quality of life and level of community reintegration, and decreased depressive symptoms are also expected. The study results will provide valuable evidence to inform future identification and evaluation of best approach to deliver stroke self-management programmes to enhance community-residing stroke survivors’ recovery.Trial registrationClinicalTrials.gov identifier: NCT02112955; date of registration: 09/04/2014
Highlights
Recovery after stroke is long-term and demanding
It is expected that stroke survivors receiving the stroke self-management programme will have improved self-efficacy, outcome expectation, and performance of stroke self-management behaviours
The results showed potential benefits of the programmes in improving stroke survivors’ self-efficacy and health-related quality of life
Summary
Optimising community-residing stroke survivors’ capability to self-manage their health is integral. Recent systematic reviews have shown that stroke selfmanagement programmes were associated with significant improvement in stroke survivors’ health-related quality of life and self-efficacy. The aim of this study is to compare the effectiveness of a nurse-led stroke self-management programme with usual care on recovery of community-residing stroke survivors. Stroke is a significant cause of disability with survivors having a higher risk of depressive symptoms and a lowered quality of life [3]. Stroke recovery is long-term and demanding, encompassing physical rehabilitation, and coping with cyclic frustrations and adapting to new life roles [4, 5]. Provision of effective community-based interventions to optimise stroke survivors’ capability to manage their post-stroke challenges is important to foster independence and early reintegration to pre-stroke life
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