Stroke Self-efficacy Research Articles

Impact of Mobile Health Literacy, Stroke-Related Health Knowledge, Health Beliefs, and Self-Efficacy on the Self-Care Behavior of Patients with Stroke

Background: The recent substantial increase in the incidence of stroke cases has resulted in high medical expenses. Stroke necessitates ongoing care, emphasizing the importance of consistent self-management. The occurrence of stroke impacts healthcare costs and has far-reaching effects on social services, encompassing disability, unemployment, and other related concerns beyond individuals and families. This study aimed to assess the impact of mobile health literacy, stroke-related health knowledge, health beliefs, and self-efficacy on self-care behaviors of patients with stroke to plan tailored self-care interventions for this patient population. Methods: This descriptive survey included 99 stroke patients from three hospitals, which provided treatment equivalent to or better than general hospitals, in City C and was conducted between 7 July 2023 and 30 May 2024. The data collected from hospitalized stroke patients were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, and multiple linear regression. Results: The self-care behavior of patients with stroke who participated in the study was 73.01 ± 12.24 points. Stroke self-efficacy was identified as a significant factor influencing stroke self-care behaviors and eating habits. Mobile health literacy and stroke self-efficacy also influenced medication and self-care behavior, whereas hypertension and stroke self-efficacy affected lifestyle self-care behaviors. Conclusions: Strengthening stroke self-efficacy, improving mobile health literacy, and addressing comorbidities such as hypertension are important for promoting self-care behavior in stroke patients.

Predictive utility of self-efficacy in early stroke rehabilitation

ABSTRACT Introduction A biopsychosocial approach entailing person-centered factors provides valuable insight to post-stroke rehabilitation potential. The consideration of an individual’s belief in their capabilities, known as self-efficacy, may prove especially informative in the inpatient rehabilitation setting where motor learning often occurs. Objective To assess the predictive utility of self-efficacy in functional independence status change during inpatient rehabilitation. Methods Individuals with stroke admitted to an inpatient rehabilitation facility (IRF) completed an assessment battery near IRF admission and discharge involving motor assessments, participant-reported self-efficacy (Stroke Self-Efficacy Questionnaire), and functional independence status evaluation (sum of self-care and mobility Quality Indicators (QI) from the IRF-Patient Assessment Instrument). Linear regression was performed to determine the predictive performance of self-efficacy on QI change during IRF stay while accounting for age, time post-stroke, and IRF length of stay. Regression procedures were repeated for separate subgroups based on initial motor impairment level. Results Thirty individuals with stroke (14 females, age = 67.0 ± 9.80 years, 10.4 ± 3.46 days post-stroke) were enrolled. Self-efficacy at IRF admission explained a significant percentage of variance in QI Change for the cohort (R2 = 30.7%, p = .001) and for the moderate to severe motor impairment subgroup (n = 12; R2 = 49.9%, p = .010). After accounting for confounders, self-efficacy remained a significant predictor for the cohort (n = 30) model. Discussion Findings generated from this work support the predictive utility of self-efficacy in early post-stroke motor recovery. The inclusion of self-efficacy in a multi-faceted evaluation framework may therefore optimize rehabilitation outcomes by providing therapists with additional knowledge to better tailor an individual’s care.

Urdu translation and cross-cultural validation of the stroke self-efficacy questionnaire

BackgroundThe Stroke Self-Efficacy Questionnaire (SSEQ) measures the self-confidence of the individual in functional activities after a stroke. The SSEQ is a self-report scale with 13 items that assess self-efficacy after a stroke in several functional domains.ObjectiveThe purpose was to translate the Stroke Self-Efficacy Questionnaire into Urdu Language and to find out the validity and reliability of Urdu SSEQ among stroke patients.MethodsThe cross-cultural validation study design was used. Following COSMIN guidelines, forward and backward translation protocols were adopted. After pilot testing on 10 stroke patients, the final Urdu version was drafted. A sample of 110 stroke patients was used to evaluate the validity and reliability of the SSEQ-U. Content and Concurrent validity were determined. The intraclass correlation coefficient and Cronbach’s alpha were used to measure internal consistency and test-retest reliability. Data analysis was performed using SPSS 25.ResultsThe final version was drafted after application on 10 stroke patients. Content validity was analyzed by a content validity index ranging from 0.87 to 1. The internal consistency was calculated by Cronbach’s alpha (α > 0.80). Test-retest reliability was determined by the Intra-class correlation coefficient (ICC2,1=0.956). Concurrent validity was determined by correlations with other scales by using the Spearman correlation coefficient; moderate to strong correlations (positive and negative) were found with the Functional Independence Measure (r = 0.76), Beck Depression Inventory (r=-0.54), Short Form of 12-item Scale (r = 0.68) and Fall Efficacy Scale (r = 0.82) with p < 0.05.ConclusionThe Urdu version was linguistically acceptable and accurate for stroke survivors for determining self-efficacy. It showed good content and concurrent validity, internal consistency and test-retest reliability.

The Swedish Stroke Self-Efficacy Questionnaire: translation and cross-cultural adaptation

ObjectiveTo translate and cross-culturally adapt the Stroke Self-Efficacy Questionnaire (SSEQ) from English to Swedish and to evaluate psychometric properties of the questionnaire.MethodsA cross-sectional study design, where the translation followed a process including initial translation, synthesis, backward translation, expert committee, and pretest. Content validity was assessed using Content validity index (CVI). Psychometric assessments included floor-ceiling effects and internal consistency.ResultsLanguage and cultural congruence were achieved, and content validity index scores were high (0.923-1). The psychometric evaluations provided acceptable outcomes concerning internal consistency, with Cronbach’s alpha scores for the total scale (0.902), the activities subscale (0.861) and the self-management subscale (0.818) respectively. Ceiling effects were evident, but no floor effects.ConclusionThis study found the Swedish version of the SSEQ promising as a tool for assessment of self-efficacy in a Swedish stroke care setting, although further psychometric assessments are recommended in future studies.

“Stroke - 65 plus. Continued active life.” A randomized controlled trial of a self-management neurorehabilitation intervention for elderly people after stroke

Purpose Post-stroke sequelae among elderly often lead to a more inactive life while carrying a risk of overburdening close relatives. The objective of the present study was to determine if a novel self-management neuro-rehabilitation intervention added to usual treatment for people with stroke over the age of 65 years improved their self-efficacy. Methods This randomised controlled trial included participants two weeks before discharge from subacute rehabilitation. All participants received usual treatment. The intervention entailed an add-on of six to eight self-management sessions lasting 45–60 min within a period of nine months after discharge. This novel neuro-rehabilitation intervention focused on promoting growth, development and self-efficacy by facilitating the participants’ self-management strategies regarding their activities and social network. All participants were assessed at baseline, three months and nine months after discharge. The primary outcome was self-efficacy measured by the Stroke Self-Efficacy Questionnaire. Results Sixty-nine individuals with stroke aged > 65 years were randomised. Their mean(SD) age was 76(6) years; 32 (46%) were female. No significant difference was found between the groups at baseline. Improvement recorded in the intervention group did not significantly differ from that of the control group with regard to primary outcome or secondary outcomes. Conclusions This novel self-management intervention had no significant effect measured by the primary outcome self-efficacy or quality of life. Furthermore, no impact was observed on participation and autonomy compared with usual treatment. Clinical trial registration—URL: ClinicalTrials.gov, NCT03183960. Registered on 12 June 2017.

Construct validity, responsiveness, minimal detectable change, and minimal clinically important difference of the stroke self-efficacy questionnaire in individuals receiving stroke rehabilitation

Purpose To assess the clinimetric properties of the Stroke Self-Efficacy Questionnaire (SSEQ) and estimate the minimal detectable change (MDC) and minimal clinically important difference (MCID) from the database of our randomized controlled trials (RCT) of individuals receiving stroke rehabilitation. Methods We retrieved the pre- and post-intervention scores of the SSEQ and Stroke Impact Scale (SIS) from 80 stroke survivors. The analysis of clinimetric properties was performed using: (1) confirmatory factor analysis and item response theory modeling (IRT) for construct validity; (2) standardized response mean and Glass’s delta for responsiveness; (3) MDC based on the standard deviation (SD) or standard error of measurement (SEM) of the SSEQ change scores; (4) MCID determined by the external anchor–SIS; (5) conditional MDC (cMDC) derived from the IRT analysis. Results There was a bi-factorial construct with excellent model-data fit and marked responsiveness. The MDC determined by the SD and SEM were 1.5 and 3.0, respectively, and the MCIDs were 3.3 and 3.7. Conclusions This study confirmed that SSEQ is a valid and reliable assessment tool for patients receiving stroke rehabilitation. We also provided practical threshold values, especially demonstrating the benefit of using individualized cMDC, to help clinicians better interpret the change in the SSEQ scores.

Exploring the status and associated factors of the readiness for return-to-work in young and middle-aged stroke patients.

Stroke increasingly affects individuals of working age. An accurate assessment of Readiness for Return-to-Work (RRTW) can help determine the optimal timing for RRTW and facilitate an early reintegration into society. This study investigates the current state of RRTW and the influencing factors among young and middle-aged stroke patients in China. A sample of young and middle-aged stroke patients hospitalized in a tertiary hospital in Henan Province between December 2021 and May 2022 were included in this study. A general information questionnaire and the Readiness for RRTW scale, the Social Support Rate Scale, the Stroke Self-Efficacy Scale, and the Fatigue Severity Scale were administered to the patients. Of the 203 patients successfully surveyed, 60 (29.6%) were in the pre-contemplation stage, 35 (17.2%) in the contemplation stage, 81 (39.9%) in the prepared for action-self-evaluative stage, and 27 (13.3%) in the prepared for action- behavior stage. Logistic regression analysis identified education level, monthly income, time to start rehabilitation therapy, social support, stroke self-efficacy, and fatigue severity as key factors affecting RRTW scale readiness in young and middle-aged stroke patients. The readiness of young and middle-aged stroke patients to Return-to-Work needs to be increased further. Healthcare professionals should consider the influencing factors of RRTW and design targeted intervention programs to facilitate a successful Return-to-Work and normal life.

Stroke self-efficacy questionnaire (SSEQ), a reliable measure of disease burden: psychometric validation of the Romanian version

Self-efficacy is a relevant outcome measure of functional status in stroke research. It can be measured with various patient-reported outcome (PRO) tools, which can be generic or disease (stroke) related. However, in Romania, there is a limited availability of such measures. The Stroke Self-Efficacy Questionnaire(SSEQ) is a specific PRO scale that measures the impact of stroke on self-management and on performance of daily activities. We conducted a two-stage study: (1) translation and cross-cultural adaptation of the SSEQ-Romanian version (SSEQ-RO) and (2) a prospective cohort clinical study designed for psychometric validation of the SSEQ-RO. For the enrolled stroke patients, Barthel index, quality of life and indexes of disease severity, such as NIHSS, MRC and mRS, were measured at baseline and ten days. For psychometric validation we assessed construct validity, reliability and repeatability. In a sample of fifty stroke patients, SSEQ-RO was found to have an excellent construct validity, excellent reliability (Cronbach's alpha = 0.92), and repeatability (ICC = 0.91). SSEQ-RO was also a good measure of disease burden in mild versus moderate to severe stroke as assessed with NIHSS (p = 0.002). In conclusion, for stroke patients, SSEQ-RO is a reliable PRO able to assess the impact of stroke on the ability to perform daily activities and, therefore can reliably be used to monitor functional status dynamics during the disease course.

Effects of Virtual Reality-Based Cognitive Rehabilitation in Stroke Patients: A Randomized Controlled Trial.

During the process of recovering functional ability after damage caused by a stroke, it is important to restore cognitive function via cognitive rehabilitation. To achieve successful rehabilitation, it is important for patients to have a sense of efficacy in their ability to manage their disease well. Therefore, a virtual reality-based cognitive rehabilitation program based on self-efficacy theory was developed, and its effects were compared with conventional and computer-assisted cognitive rehabilitation. The virtual reality-based cognitive rehabilitation program consisted of sessions lasting 30 min each five days a week for eight weeks. After applying the virtual reality-based cognitive rehabilitation program, there were significant differences in group-by-time interactions regarding stroke self-efficacy, cognitive function, visual perception, activities of daily living, and health-related quality of life. In addition, there were significant group differences among the three groups in terms of stroke self-efficacy and health-related quality of life. In conclusion, our virtual reality-based cognitive rehabilitation program developed based on self-efficacy theory is effective for inpatients with stroke and improves their stroke self-efficacy, cognitive function, visual perception, activities of daily living, and health-related quality of life.

Translation and validation of the Persian version of the Stroke Self-Efficacy Questionnaire in stroke survivors

Background The Stroke Self-Efficacy Questionnaire (SSEQ) is a self-report scale that measures stroke survivors’ self-efficacy and covers specific domains of functioning after stroke. Objectives We aimed to determine the validity and reliability of the Persian version of the SSEQ. Methods This descriptive cross-sectional study included 124 stroke patients in the sub-acute phase (between 2 weeks and 3 months of stroke onset). The original SSEQ was translated to Persian and back-translated to English. Demographic, neurologic examination, ‘Persian Stroke Self-Efficacy Questionnaire (SSEQ-P)’, and ‘General Self-Efficacy Scale’ (GSE-10) data were collected. The reliability of the questionnaire was evaluated by test–retest assessment among 30 people with stroke at an interval of two weeks. Factor analysis was used to assess the validity of SSEQ-P. Cronbach’s alpha assessed internal consistency in all participants. Statistical analysis was performed by SPSS software version 23 and SmartPLS version 3. Results In this study, the mean of SSEQ scores was 87.99 ± 37.09. Content Validity Ratio (CVR) and Content Validity Index (CVI) were favorable. Convergent validity of the questionnaire was reported (r = 0.669) using GSE. Factor loadings of items in SSEQ ranged from 0.41 to 0.92. Validity indices (AVE = 0.75, SRMR = 0.07) showed that the single-factor model of the present study owns a favorable fit. Test–retest reliability and Cronbach’s alpha values of SSEQ in the present study were calculated at 0.80 and 0.97, respectively. Conclusions The Persian version of the SSEQ depicted acceptable reliability and validity and can be utilized to evaluate the self-efficacy of patients with stroke. HIGHLIGHTS Stroke Self-Efficacy Questionnaire (SSEQ) is a self-report scale that measures stroke survivors’ self-efficacy. The Persian version of the SSEQ demonstrated acceptable reliability and validity and can be used in stroke patients.

The effect of sequential combination of mirror therapy and robot-assisted therapy on motor function, daily function, and self-efficacy after stroke

Robot-assisted therapy and mirror therapy are both effective in promoting upper limb function after stroke and combining these two interventions might yield greater therapeutic effects. We aimed to examine whether using mirror therapy as a priming strategy would augment therapeutic effects of robot-assisted therapy. Thirty-seven chronic stroke survivors (24 male/13 female; age = 49.8 ± 13.7 years) were randomized to receive mirror therapy or sham mirror therapy prior to robot-assisted therapy. All participants received 18 intervention sessions (60 min/session, 3 sessions/week). Outcome measures were evaluated at baseline and after the 18-session intervention. Motor function was assessed using Fugl-Meyer Assessment and Wolf Motor Function Test. Daily function was assessed using Nottingham Extended Activities of Daily Living Scale. Self-efficacy was assessed using Stroke Self-Efficacy Questionnaires and Daily Living Self-Efficacy Scale. Data was analyzed using mixed model analysis of variance. Both groups demonstrated statistically significant improvements in measures of motor function and daily function, but no significant between-group differences were found. Participants who received mirror therapy prior to robot-assisted therapy showed greater improvements in measures of self-efficacy, compared with those who received sham mirror therapy. Our findings suggest that sequentially combined mirror therapy with robot-assisted therapy could be advantageous for enhancing self-efficacy post-stroke.Trial registration: ClinicalTrials.gov Identifier: NCT03917511. Registered on 17/04/2019, https://clinicaltrials.gov/ct2/show/ NCT03917511.

Correlation between family support and self-efficacy in stroke survivors

Introduction: The sudden change in condition due to disability in stroke patients impacts their psychological condition and behavior. Low self-efficacy in stroke patients can affect depression and low quality of life. One of the factors that can increase self-efficacy in stroke patients is family support. This study analyzed the correlation between family support and self-efficacy in stroke survivors. Methods: This cross-sectional study involved seventy-one stroke survivors who were included in the inclusion criteria selected through purposive sampling. Data were collected using a demographic data questionnaire, the Family Support Questionnaire, and the Stroke Self-Efficacy Questionnaire (SSEQ). The data were analyzed using the Spearman rho correlation test with a significance level of α ≤ 0.05. Results: Half of the participants were women (50.7%), married (88.7%), and aged (Mean±SD, 56,23± 6,273). The result showed a significant correlation between family support and self-efficacy (p = 0,000) with medium relationship strength (r = 0,58). Conclusion: The higher the family support, the higher the self-efficacy of stroke patients. Nurses are expected to be able to provide family education to provide continuous support to family members who suffer from a stroke so that self-efficacy in stroke survivors increases.

Characterizing the impact of multiple chronic conditions on return to participation in chronic stroke survivors

ABSTRACT Background Each year, 795,000 Americans experience a stroke. As stroke mortality declines, more individuals are in the chronic phase of recovery (>6 months post-stroke). Over 80% of stroke survivors have multiple, chronic health conditions (MCC). While the relationship between MCC and mortality and function during acute recovery has been explored, less is known about how MCC burden affects participation in chronic stroke survivors. Objective This study investigated whether MCC burden is related to participation in those with chronic stroke. Methods Two hundred and sixty-six participants with chronic (≥6 months) stroke were included in this cross-sectional and retrospective analysis. Participants had a mean age of 62.2 ± 12.8 years, and time since stroke (TSS) of 36.0 ± 44.6 months (114F/152 M). Participants completed the 6-minute Walk Test (6MWT), Activities-Specific Balance Confidence Scale (ABC), Modified Cumulative Illness Rating Scale (MCIR) to quantify the presence and severity of chronic illness across 14 body systems, and the Stroke Impact Scale – Participation subscale (SIS-P). Participation (SIS-P) was the dependent variable. Independent variables were entered into a sequential regression model in three blocks: demographic variables, physical capacity (6MWT distance) and balance self-efficacy (ABC), and MCC burden (MCIR). Results After adjusting for age, sex, and time since stroke, physical capacity and balance self-efficacy explained 31.4% (p < 0.001), and the MCC burden explained 2.0% (p = 0.004). Higher participation was related to lower MCC burden. Conclusions MCC burden is a significant contributor to variance in participation in chronic stroke survivors, above and beyond demographics, physical capacity, and self-efficacy, and therefore should be considered when creating rehabilitation programs to improve participation.

The Risk Factors of Self-Management Behavior among Chinese Stroke Patients.

Stroke is associated with a high number of disability-adjusted life years globally, so long-term care is necessary and important for those survivors, so self-management is becoming a more significant concept in stroke rehabilitation. Ischemic stroke patients (n = 354) were enrolled from the outpatient department of Neurology in West China Hospital from September 2018 to December 2019. The general demographic and disease-related data of stroke patients were collected. The stroke self-efficacy questionnaire (SSEQ), the brief cognition questionnaire (BIPQ), and the stroke self-management scale (SSMS) were used to collect data on self-efficacy, disease cognition, and self-management behavior separately. The chi-square test, Fisher exact test, independent sample t-test, and Mann-Whitney U test were used for comparison among groups. The logistic regression analysis was used to explore the independent risk factors of the different levels of self-management behavior in stroke patients. The score of self-management among Chinese stroke patients was 151.07 ± 18.53. Multivariate analysis showed that the way of paying medical expenses (OR = 3.215, 95% CI (1.130, 7.769)), self-management efficacy (OR = 2.467, 95% CI (1.534, 3.968)), health education before discharge (OR = 2.354, 95% CI (1.457, 3.802)), age (elder) (OR = 2.060, 95% CI (1.265, 3.355)), educational level (OR = 1.869, 95% CI (1.169, 2.988)), and mRS score (OR = 1.850, 95% CI (1.129, 3.031)) were statistically significant (P < 0.05). The self-management behavior of Chinese stroke patients was at the middle level. Patients with medical insurance, high self-efficiency of management, and better limb function may have better self-management behavior. Besides, patients with a high educational level who accept health education before discharge may also have better self-management behavior. For patients, it is important to know this disease in the right way and set up the faith to take care of themselves independently gradually. For medical staff, it is necessary and important to give all patients health education about self-management before discharge. It is urgent to call for attention to this disease, and the government and all of society should give more support to stroke patients.

Cross–cultural adaptation and approbation of the questionnaire "Stroke Self-efficacy Questionnaire" ("Self-efficacy after stroke").

The article presents a step-by-step description of the procedure for cross-cultural adaptation of the questionnaire on the Russian sample. The goal is to adapt and test the Stroke Self-efficacy Questionnaire on stroke patients with an assessment of internal consistency and convergent validity. 77 patients of the Tomsk Regional Vascular Center filled out the Russian-language version of the "SSEQ" and the "Scale of general self-efficacy" (R. Schwarzer, M. Yerusalem, adapted by V.G. Romek) were studied. When filling out 13 scales of the questionnaire, patients assessed their abilities, capabilities, resources in performing everyday tasks after a stroke on a scale from 0 to 10, where 0 is absolutely not sure and 10 is absolutely sure. To assess convergent validity, post-stroke patients filled out a "Scale of general self-efficacy" consisting of 10 items, each of which has 4 degrees of consent of the respondent from "absolutely incorrect" to "absolutely true". The total values on the scale (from 10 to 40 points) reflect the overall indicator of subjective assessment of personal effectiveness. The article presents the psychometric characteristics of the test and descriptive statistics. The internal consistency of the test was determined by the Kronbach method. The coefficient is generally equal to 0.875. Adaptation and testing of the questionnaire "Self-efficacy after stroke" in many countries has shown good validity results. Cross-cultural adaptation of the questionnaire "Self-efficacy after stroke" was conducted in Russia for the first time. The advantages of using this questionnaire include the possibility of using it as an express technique in the work of a clinical psychologist within a multidisciplinary team to assess the motivational component of rehabilitation potential in the system of staged rehabilitation treatment.

Predicting Arm Nonuse in Individuals with Good Arm Motor Function after Stroke Rehabilitation: A Machine Learning Study.

Many stroke survivors demonstrate arm nonuse despite good arm motor function. This retrospective secondary analysis aims to identify predictors of arm nonusers with good arm motor function after stroke rehabilitation. A total of 78 participants were categorized into 2 groups using the Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE) and the Motor Activity Log Amount of Use (MAL-AOU). Group 1 comprised participants with good motor function (FMA-UE ≥ 31) and low daily upper limb use (MAL-AOU ≤ 2.5), and group 2 comprised all other participants. Feature selection analysis was performed on 20 potential predictors to identify the 5 most important predictors for group membership. Predictive models were built with the five most important predictors using four algorithms. The most important predictors were preintervention scores on the FMA-UE, MAL-Quality of Movement, Wolf Motor Function Test-Quality, MAL-AOU, and Stroke Self-Efficacy Questionnaire. Predictive models classified the participants with accuracies ranging from 0.75 to 0.94 and areas under the receiver operating characteristic curve ranging from 0.77 to 0.97. The result indicates that measures of arm motor function, arm use in activities of daily living, and self-efficacy could predict postintervention arm nonuse despite good arm motor function in stroke. These assessments should be prioritized in the evaluation process to facilitate the design of individualized stroke rehabilitation programs to reduce arm nonuse.

Effects of Stroke Rehabilitation Using Gait Robot-Assisted Training and Person-Centered Goal Setting: A Single Blinded Pilot Study

Many stroke survivors have difficulties due to the mobility and activities required in daily living. A walking impairment negatively affects the independent lifestyle of stroke patients, requiring intensive post-stroke rehabilitation. Therefore, the purpose of this study was to examine the effects of stroke rehabilitation using gait robot-assisted training and person-centered goal setting on mobility, the activities of daily living, stroke self-efficacy, and health-related QoL in stroke patients with hemiplegia. An assessor-blinded quasi-experimental study with a pre-posttest nonequivalent control group was used. Participants who were admitted to the hospital with a gait robot-assisted training system were assigned to the experimental group, and those without gait robots were assigned to the control group. Sixty stroke patients with hemiplegia from two hospitals specialized in post-stroke rehabilitation participated. Stroke rehabilitation using gait robot-assisted training and person-centered goal setting for stroke patients with hemiplegia was conducted for a total of six weeks. There were significant differences between the experimental group and control group in the Functional Ambulation Category (t = 2.89, p = 0.005), balance (t = 3.73, p < 0.001), Timed Up and Go (t = -2.27, p = 0.027), Korean Modified Barthel Index (t = 2.58, p = 0.012), 10 m Walking test (t = -2.27, p = 0.040), stroke self-efficacy (t = 2.23, p = 0.030), and health-related quality of life (t = 4.90, p < 0.001). A gait robot-assisted rehabilitation using goal setting for stroke patients with hemiplegia improved gait ability, balance ability, stroke self-efficacy, and health-related quality of life in stroke patients.

Abstract WMP39: Effects Of A Home Visiting And Phone Coaching Self-management Program For Stroke Survivors: A Randomized Controlled Trial

Introduction: Systematic reviews show that self-management interventions were associated with significant improvements in stroke survivors’ activities of daily living and quality of life. However, the programmes were largely group-based and held in community settings. It may limit access by stroke survivors who have greater physical impairment or are more vulnerable to adverse events. Aim: This study aimed to develop and evaluate the effects of a new, 8-week, individual-based self-management program on stroke survivors’ self-efficacy in performing self-management behaviors and level of community reintegration. Methods: A 2-arm randomized controlled trial was conducted. A convenience sample of adults who had a first-ever/recurrent ischemic/hemorrhagic stroke were recruited from community-based rehabilitation organisations and support groups. The participants in the intervention group received the self-management program and usual care. The program included four home visits and five phone coaching sessions held weekly over eight weeks. It was led by a healthcare professional who conducted home visits and supported by a trained volunteer who provided phone coaching. Access to the program website and a workbook with essential information about self-management and peer survivors’ sharing of survival experiences in videos was also provided. The generalised estimating equations (GEE) model was used to compare the difference in outcomes between the intervention and control groups at post-intervention compared to baseline. Results: A total of 134 participants (mean age=64.06 years; SD=12.69) were recruited. The mean years after a stroke was 4.19 years (SD=5.07). The adjusted GEE analysis results showed that participants in the intervention group improved significantly more in total scores of the Stroke Self-Efficacy Questionnaire and the Reintegration into Normal Living Index at follow-up with respect to baseline compared to those in the control group. Conclusions: The results supported the benefits of the self-management program. The model of collaboration between healthcare professionals and trained volunteers in the program delivery could be further explored to optimize the continuity of self-management support to stroke survivors.

Abstract 158: An Evaluation Of Stroke Survivors' Self-efficacy In Self-management Using A Stroke Telehealth Service

Background: Previous studies indicate that stroke survivors encounter difficulties in participating in self-management programs because of lack of transportation to rehabilitation centres and unsuitable scheduling. A virtual multidisciplinary stroke care clinic (VMSCC) that builds on the advantages of self-management programs to promote survivors’ recovery and improve caregivers’ outcomes was developed. Methods: A VMSCC was set up to facilitate the interactions between the participants and the healthcare professionals. Participants received a device kit containing a tablet and a clinically validated wireless home blood pressure monitoring device. It was encouraged that survivors monitor their blood pressure daily to take an active role in managing their health. Registered nurses conducted Skype-based video calls with stroke survivors on issues relating to stroke self-management. A nurse reviewed blood pressure data before video calls and used online tools to reinforce self-management knowledge and skills during the video calls. A hotline for psychological and non-urgent health concerns was also maintained by the nurse in the call centre. To determine its effectiveness on stroke survivors' self-efficacy in self-management, a two-arm randomised controlled trial was conducted. We measured self-efficacy outcome using the Stroke Self-Efficacy Questionnaire at baseline (shortly before discharge) and 3 and 6 months after study initiation. Results: We recruited 274 participants from 10 Hong Kong's public hospitals. At 3 months (T1) and 6 months (T2), survivors in the control group demonstrated no significant difference in the change of self-efficacy with respect to T0 (baseline). The generalized estimating equations analysis showed a significant change and estimated additional improvement in self-efficacy in the intervention group at T2. Discussion: VMSCC's intervention was based on self-efficacy theory, which identified perceptions of personal capability as a significant variable associated with stroke outcomes. The development of a self-management program based on the self-efficacy theory was further supported by significant improvements in self-efficacy in the intervention group in this study.

Relationships between Self-Efficacy and Post-Stroke Activity Limitations, Locomotor Ability, Physical Activity, and Community Reintegration in Sub-Saharan Africa: A Cross-Sectional Study.

Stroke self-efficacy is under-investigated in sub-Saharan Africa. In particular, studies focusing on the relationship between self-efficacy and post-stroke functional outcomes are scarce. This cross-sectional study aimed to explore the association between self-efficacy and post-stroke activity limitations, locomotor ability, physical activity, and community reintegration in Benin, a sub-Saharan African country. To achieve this purpose, a selection of stroke patients was made from the admission registers of the physiotherapy clinics (rehabilitation units) of three reference hospitals in Benin from January to April 2018. Stroke patients who were still continuing their rehabilitation sessions were informed by direct contact. Those who had already finished their sessions were informed by telephone. Sixty stroke patients of those contacted gave their consent and were recruited for this study. The sample consisted of 44 men and 16 women with a mean age of 56.7 ± 10.4 years. Activity limitations, locomotor ability, physical activity, community reintegration, and self-efficacy were self-reported using ACTIVLIM-Stroke, Abiloco-Benin, the Africa francophone version of the International Physical Activity Questionnaire (IPAQ-AF), the Reintegration to Normal Living Index (RNLI), and a French version of the Stroke Self-efficacy Questionnaire (SSEQ-F), respectively. Spearman's rank correlation coefficients (ρ) were calculated to characterize the relationship between self-efficacy and activity limitations, locomotor ability, physical activity, and community reintegration. According to the results, self-efficacy showed a moderate correlation with physical activity (ρ = 0.65; p < 0.001) and high correlations with activity limitations (ρ = 0.81; p < 0.001), locomotor ability (ρ = 0.72; p < 0.001), and community reintegration (ρ = -0.84; p < 0.001). Thus, self-efficacy emerges as an important factor associated with the functional recovery of stroke patients in sub-Saharan Africa.