Stroke Self-management Program Research Articles

Perspectives on Adaptation in a Stroke Self-Management Program: A Multiple Case Study

Perspectives on Adaptation in a Stroke Self-Management Program: A Multiple Case Study

Building Bridges between People with Stroke, Families, and Health Professionals: Development of a Blended Care Program for Self-Management.

Evidence-informed interventions for stroke self-management support can influence functional capability and social participation. People with stroke should be offered self-management support after hospital discharge. However, in Portugal, there are no known programs of this nature. This study aimed to develop a person-centered and tailored blended care program for post-stroke self-management, taking into account the existing evidence-informed interventions and the perspectives of Portuguese people with stroke, caregivers, and health professionals. An exploratory sequential mixed methods approach was used, including qualitative methods during stakeholder consultation (stage 1) and co-production (stage 2) and quantitative assessment during prototyping (stage 3). After ethical approval, recruitment occurred in three health units. Results from a literature search led to the adaptation of the Bridges Stroke Self-Management Program. In stage one, 47 participants were interviewed, with two themes emerging: (i) Personalized support and (ii) Building Bridges through small steps. In stage two, the ComVida program was developed, combining in-person and digital approaches, supported by a workbook and a mobile app. In stage three, 56 participants evaluated prototypes, demonstrating a strong level of quality. Understandability and actionability of the developed tools obtained high scores (91-100%). The app also showed good usability (A-grade) and high levels of recommendation (5 stars).

Stroke self-management program based on health behavior theory on neurological function and quality of life of post-ischemic stroke patients

Introduction: The two biggest issues for post-ischemic stroke patients are disability and mortality. Patients with post-ischemic stroke have a decline in quality of life due to alterations in neurological function. Additionally, post-stroke patients require ongoing education to improve their independence in completing daily tasks. His research thus sought to examine the impact of stroke self-management on post-ischemic stroke patients' neurological function and quality of life using the framework of health behavior theory. Methods: The sampling method utilized in the study design was successive sampling with a quasi-experimental design to choose the sample following the inclusion and exclusion criteria. 58 intervention and control groups were created from a total sample of 116 respondents. This research used the National Institute of Health Stroke Scale (NIHSS) and Stroke Specific Quality of Life Scale (SS-QoL). Statistical analysis using t-test with p<0.5. Results: According to the findings, the mean neurological function in the intervention group before and after the intervention was 8.259, whereas the mean quality of life before and after the intervention was -20.93. In the control group, the mean neurological function was -0.179 before and after the intervention, whereas the mean quality of life was 0.069. Data analysis revealed a significant difference between health behavior therapy-based stroke self-management programs and neurological function and quality of life in post-ischemic stroke patients with p = 0.00. Conclusion: Stroke self-management based on health behavior theory can be applied over the long term to help patients’ neurological function and quality of life.

Patients’ experience of and participation in a stroke self-management programme, My Life After Stroke (MLAS): a multimethod study

ObjectiveA self-management programme, My Life After Stroke (MLAS), was developed to support stroke survivors. This evaluation reports patients’ experience.DesignMultimethod, involving interviews and questionnaires.Setting23 general practices in the intervention arm of...

Volunteer Engagement in a Stroke Self-Management Program: Qualitative Analysis of a Hybrid Team of Healthcare Providers and Trained Volunteers.

Stroke recovery is a complex, multidimensional and heterogeneous process. Volunteer engagement improves the delivery of interventions in stroke rehabilitation programs but is under-utilized due to poor role clarity and other program-related concerns. We evaluated healthcare providers’ and volunteers’ perceptions of volunteer engagement in an 8-week self-management program that provided self-management support for community-dwelling stroke survivors. Using a qualitative design, we conducted individual, semi-structured interviews with a purposive sample of 5 trained healthcare providers and 18 volunteers. The participants shared their experiences of supporting survivors, perceptions of volunteer engagement, and areas of improvement to optimize volunteer support. Three main themes and six subthemes emerged: bilateral exchange between healthcare providers/volunteers and survivors; adoption of individualized approaches; and suggestions for optimizing volunteer contributions. Volunteer engagement can be optimized by developing well-designed programs with sufficient role clarity, strengthened collaborations with healthcare providers and adequate training. Our findings highlighted the contributions of trained volunteers in supporting stroke survivors’ self-management. Future research should evaluate the use of peer and healthcare professional volunteers in such programs and build community capacity to support stroke survivors’ recovery.

Clinicians' Perspectives on the Barriers and Facilitators to Implementation of An Evidence-Based Stroke Self-Management Program

<h3>Research Objectives</h3> To explore barriers and facilitators to stroke self-management and to elicit feedback on the implementation of an evidence-based self-management program for stroke survivors. <h3>Design</h3> A qualitative descriptive study conducted via Skype or Zoom. <h3>Setting</h3> Clinicians were recruited from a comprehensive stroke center in the US southwestern region. <h3>Participants</h3> Ten clinicians, who provide direct care or services to persons with stroke, participated in one-on-one semi-structured interviews. The multi-disciplinary group of clinicians included a nurse/care manager (n=1), speech-language pathologist (n=1), occupational therapists (n=2), physical therapists (n=2), and physicians (n=4). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Semi-structured interviews addressed facilitators and barriers to stroke self-management, the role of health care providers in facilitating stroke self-management, and feedback on how to implement successfully an evidence-based stroke self-management program. The clinician interviews lasted 30-45 minutes, were audio recorded, and transcribed by a professional transcription company. Two trained, independent coders analyzed and coded the transcripts. <h3>Results</h3> Thematic content analysis revealed a variety of facilitators and barriers to stroke self-management. Some facilitators identified include family/caregiver support, maintaining a healthy lifestyle, appropriate medication management, and having financial resources. Barriers to self-management include being uninsured, transportation, impaired cognition, lack of family support, limited financial resources, poor medication or blood pressure management, cultural beliefs, and poor health literacy. Clinicians provided a variety of profession-specific strategies to support patient self-management. Major considerations for implementing a stroke self-management program included timing, educational content, access for uninsured patients, addressing transportation needs, accounting for cognitive deficits, improving patient compliance, potential competition with other programs, funding to maintain the program, having a clear organizational structure, and need to evaluate the feasibility and implementation of the program. <h3>Conclusions</h3> The results of this study provides numerous considerations when implementing an evidence based stroke self-management program. Such programs should be low-cost, multidisciplinary in nature, incorporate family/caregivers, and consider the access and educational needs of stroke survivors from diverse backgrounds without transportation, insurance and financial resources. <h3>Author(s) Disclosures</h3> The authors have no disclosures to report.

Exploring community-dwelling stroke survivors' experiences of receiving a nurse-led theory-based stroke self-management programme: A qualitative study.

International evidence-based guidelines recommend self-management support for stroke survivors to improve their health outcomes. We developed a 4-week nurse-led stroke self-management programme (SSMP) and conducted a randomised controlled trial to assess its effects. This paper reports the findings of a qualitative study nested within the randomised controlled trial to explore stroke survivors’ experiences of SSMP participation. Semi-structured interviews were conducted with all adult participants who were clinically diagnosed with a first or recurrent ischaemic or haemorrhagic stroke, residing at home, communicable in Cantonese, had a Montreal Cognitive Assessment score below the second percentile, and participated in at least 1 SSMP session. All interviews were conducted in Cantonese, lasted approximately 45 minutes, and were audio-recorded. Interview data were transcribed verbatim and analysed thematically. Sixty-four stroke survivors (mean age 66.33 years, SD 12.34) were recruited, and 59 were interviewed via phone immediately after completion of SSMP. Three themes were derived. Overall, participants were satisfied with the SSMP. Their understanding of self-management was improved, and they recognised its importance in recovery. Their confidence in self-management was also enhanced through the use of multifaceted strategies. Suggestions were made to enhance their participation experiences, including increased home visits and group sessions, making group session attendance optional and arranging them more accessibly, meeting the survivors who shared their survival experiences in the videos, and access to the videos online. This study concurred that the SSMP enhanced stroke survivors’ self-efficacy in self-management. Rearrangement of the programme format and enhancements in accessibility could be further examined to enable more effective stroke self-management.

Implementing and evaluating the Bridges stroke self-management programme into a New Zealand district health board stroke service: A case study

Implementing and evaluating the Bridges stroke self-management programme into a New Zealand district health board stroke service: A case study

Survivors’ Perspectives: Exploring Occupational Adaptation in Stroke Self-Management Programs

Abstract Date Presented 03/28/20 Stroke self-management programs provide a comprehensive approach to managing the day-to-day aspects of living with the effects of stroke. The impact of these programs on participants has not been previously explored. This presentation will share the results of a qualitative study exploring the process of adaptation as described by five stroke survivors following their participation in a stroke self-management program. Primary Author and Speaker: Riqiea Kitchens

Examining the feasibility and effectiveness of a culturally adapted participation-focused stroke self-management program in a day-rehabilitation setting: A randomized pilot study

ABSTRACT Background: Stroke survivors find it difficult to participate in daily activities, despite their improvement throughout the rehabilitation process. Thus, it has been questioned whether day-rehabilitation services provide adequate preparation for participation and reintegration into the community. Self-management programs can improve survivors’ self-efficacy to manage their condition and participation. Improving Participation After Stroke Self-Management program (IPASS) is an occupational therapy-based group intervention developed in the United States, which has been effective in improving participation outcomes. Objective: To evaluate the feasibility and effectiveness of the IPASS adapted for an Israeli population of individuals admitted to a day-rehabilitation center after stroke. Methods: A single-center, randomized, assessor-blind study was conducted. Eligible participants were randomized to receive the IPASS (intervention group), in addition to standard individual therapy or standard care only (control group). Feasibility was based on attendance rate and a feedback questionnaire. Effectiveness was evaluated with the Functional Independence Measure (FIM), the Reintegration to Normal Living Index (RNLI) and self-efficacy questionnaires. Results: Sixty participants were included, of which 39 completed baseline and post-intervention evaluations. The intervention group improved significantly in the FIM scores (p < .01), as compared to the control group (p > .05). Moderate effect sizes (≥0.35) were found for the FIM and RNLI, and large effect sizes (≥0.65) for two subcategories in the participation self-efficacy questionnaire. Conclusions: The results support the feasibility of the adapted IPASS, and show a trend for positive effects in improving participation and self-efficacy in managing participation in home and community activities, for an Israeli post-stroke population.

Abstract TP167: Behavioral Change Intervention and Predictors of Self-Management Blood Pressure Control in Underserved Post-Stroke Population

Background: Although stroke is an acute event caused by chronic conditions such as high blood pressure (BP), diabetes and unhealthy lifestyle, 80% of all strokes are preventable through awareness and risk factor management. Little is known about predictors of BP control in underserved post-stroke patients engaged in self-management (SM). We examined association between patients Readiness to Change (RTC) behavioral intention and demographics, on BP control following implementation of six weeks risk factor reduction program (V-STOP) delivered via videoconferencing to stroke survivors with focus on the BP control. Methods: Under pre/post quasi-experimental design, patients participated in six weeks educational sessions aimed to control modifiable stroke risk factors. Sixty-six patients participated and 44 completed RTC scale and provided BP measurements at baseline and at the end of intervention. The average patient’s age was 58, 57% were male and majority (71%) were white. Almost half of patients finished high school, 65% had annual income less than $25,000, 55% did not have any insurance. The association between predictors and BP control was evaluated using logistic regression in univariate and multivariate analysis. Statistically or biologically significant predictors were considered in multivariate analysis. Results: Multivariate analysis showed that patient age and education impact BP control endpoint. BP control frequency at six weeks was 78% for patients who were younger than 60 years and had no higher education (n=14, reference group), 88% for those younger than 60 who had higher education (n=7, OR=2, p=0.6), and 92% for patients who were older than 60 and had higher education (n=11, OR=3.1, p=0.034). BP control frequency was lowest (62%) for patients older than 60 years who had not received higher education (n=8, OR=0.46, p=0.3). No other factors evaluated impacted BP control. Conclusion: Our results suggest that older patients who received education higher than high school may be more likely to benefit from the stroke SM program implemented. Targeted programs may be required for patients with different demographics. No significant associations were found between RTC scores and BP control. These findings require validation in larger datasets.

Stroke self-management and the role of self-efficacy

Purpose This study explored the impact of a 12-week stroke self-management program on occupational performance, the role of self-efficacy on improving occupational performance and the potential barriers and facilitators to self-efficacy as reported by clients and careers. Materials and methods Participants (n = 40) were recruited to participate in a self-management program after admission to hospital with diagnosis of stroke. A pre-post study was conducted and data were obtained from participants using: the Canadian Occupational Performance Measure, Stroke Self-efficacy Questionnaire, and semi-structured interviews with five participants and two careers. Data analysis was conducted using parametric statistics and thematic analysis. Results Significant improvements were observed in occupational performance (t = 11.2; p = 0.001) and satisfaction (t = 9.7; p = 0.001). Self-efficacy was shown to be a significant mediator to improvements in occupational performance (F = 7.08; p < 0.01) and satisfaction (F = 6.52; p = 0.02). Three key barriers and facilitators emerged from the thematic analysis: “Support in making the transition home,” “Getting back to normal,” and “Reflecting on shared experiences.” Conclusions Engagement in a stroke-specific self-management program can improve client-perceived occupational performance and satisfaction. Self-efficacy was shown to be a mediating variable to occupational performance improvements. Future research should explore further the facilitatory strategies of self-efficacy during stroke self-management programs to maximize rehabilitation outcomes. Implications for rehabilitation Multi-modal self-management programs are recommended as effective for improving client-perceived occupational performance of people who have experienced stroke. Returning to valued occupations, goal setting, shared experiences, and local support are recommended components of a self-management program for stroke survivors. Focusing on enhancing client confidence, competence, and self-efficacy is recommended to achieve occupational performance gains through self-management. Occupational therapy coaching is recommended to guide participants through the self-management processes of goal-setting, shared problem-solving, performance evaluation, and reflection.

Coaching Ongoing Momentum Building On stroKe rEcovery journeY (’COMBO-KEY'): a randomised controlled trial protocol

IntroductionSystematic reviews reporting self-management interventions are associated with significant improvements in stroke survivors’ self-efficacy, health-related quality of life (HRQoL) and independence. However, common barriers such as transportation and availability of...

Attitudes of healthcare professionals towards self-management for patients with stroke

Self-management approaches towards stroke rehabilitation are gaining more attention due to emerging evidence of their impact on patient outcomes. This mixed methods study explored the attitudes of healthcare professionals (HCPs) towards stroke self-management. The Bridges Stroke Self-Management Programme (Bridges SSMP) training was delivered to 51 HCPs in New Zealand. Questionnaires were completed by consenting participants (n = 43) prior to administration of the Bridges SSMP training. In-depth, semi-structured interviews were conducted with three participants. The General Inductive Approach was used for thematic analysis of the qualitative data. The resulting overarching theme was “integrating the self-management concept into practice”, which encompasses organisational, contextual and individual factors that HCPs feel are challenges when applying self-management. Two contributors to this theme – “education” and “facilitating empowerment” – emerged as barriers or enablers, respectively, to putting self-management into practice. Questionnaire data showed HCPs were confident in their capability of self management concepts yet did not frequently use them in practice. Healthcare professionals were mostly positive about the concept of self-management but challenges and barriers were evident when applying this to practice. Hence, they may require a deeper understanding of the principles of self-management and become more familiar with the process by applying the principles of self-management in their own lives.

An Evaluation of the Family Informal Caregiver Stroke Self-Management Program.

Caregivers are often unprepared and overwhelmed with the responsibilities of providing care to stroke survivors, which can lead to negative physical and psychological effects. To evaluate the impact of the Family Informal Caregiver Stroke Self-Management (FICSS) program on burden and life changes resulting from providing care among family caregivers of stroke survivors. A prospective pre-test and post-test design using quantitative and qualitative data was used to evaluate the program with a convenience sample of 42 caregivers. The four-module facilitated program consisted of small group-guided discussion. Quantitative evaluations were completed at baseline, 2 weeks and 6 months (post-intervention), and qualitative data were collected at 2 weeks and 6 months. Life changes and burden were measured using the Bakas Caregiving Outcome Scale (BCOS) and the Oberst Caregiving Burden Scale (OCBS), respectively. The BCOS scores increased consistently over time, showing significant differences at 6 months compared with 2 weeks (mean difference: 5.29, 95% confidence interval [CI]: 0.30-10.28, p=0.04) and baseline (mean difference: 7.58, 95% CI: 2.92-12.23, p=0.001). The OCBS time scores decreased consistently over time, showing a significant difference at 6 months compared with baseline (mean difference: -5.20, 95% CI: -0.96 to -9.44, p=0.02). The OCBS difficulty scores fluctuated over time, resulting in no overall difference from baseline to 6 months. Qualitative themes were consistent with the positive quantitative findings. Study results suggest that the FICSS program may result in reduced caregiver burden and improved life changes resulting from providing care.

Feasibility and Effectiveness of an Integrated Cognitive Behavioral Treatment to Address Psychological Distress in a Stroke Self-Management Program

This is a case-study of a Hispanic man who had an ischemic stroke and was participating in a stroke self-management (SSM) program. He was identified as having comorbid symptoms of anxiety and depression that were not addressed by the SSM program and was subsequently enrolled in the Enhance Psychological Coping after Stroke (EPiC) program. EPiC is a telephone-based cognitive-behavioral treatment integrating mental and stroke-related behavioral health principles that is delivered concurrent to the SSM program. Over the course of six sessions, the participant learned psychological symptom and behavioral monitoring, thought stopping, cognitive restructuring, deep breathing, calming thoughts, social support, and problem-solving skills aimed at overcoming barriers to engagement in behaviors taught in the SSM program. Client-centered psychological distress and behavioral health treatment goals were integrated into each session. The client demonstrated reduced anxiety symptoms and improved stroke SSM behaviors at 6, 12, and 18 weeks after the initiation of treatment. He also improved in disability, social role limitations, quality of life, and stroke self-efficacy at 18 weeks following the initiation of treatment. This case study demonstrates that incorporating an integrated cognitive behavioral treatment to an SSM program can be beneficial for decreasing psychological symptom barriers to SSM, which may reduce the risk of stroke recurrence.

Adapting the Bridges stroke self-management programme for use in Australia

Background/Aims: This study explored the applicability of the UK Bridges stroke self-management programme for use in an Australian health care context, and specifically, the need for any modification to the workbook tool. Methods: Data were collected via survey from Australian stroke professionals who had attended a 2-day Bridges training workshop and from focus groups with community-based stroke survivors across three different states. Findings: A total of 18 out of 30 workshop attendees (60%) completed the electronic survey. Most (94%) agreed that the training had advanced their practice with a stronger focus on self-management principles and that they would recommend the training to colleagues. The majority (71%) had incorporated some Bridges stroke self-management programme principles or strategies into their practice; although 81% reported a range of barriers to doing so. A total of 26 stroke survivors attended focus groups. The workbook was considered to be a useful tool to support self-management. Suggestions for change included the addition of some culturally contextualised patient stories and locally relevant stroke support resources. Conclusions: Stroke survivors and health professionals recognised the need for structured training, such as the Bridges stroke self-management programme, to develop self-management skills and knowledge post stroke. The Bridges stroke self-management programme workbook would be able to be used in Australia with minor modification.

Stroke Self-Management Support Improves Survivors' Self-Efficacy and Outcome Expectation of Self-Management Behaviors.

Evidence shows self-management programs are associated with improved recovery outcomes. This article reports on the effectiveness of a new nurse-led self-efficacy-based stroke self-management program. A randomized controlled trial of participants recruited from 3 acute stroke units was conducted. The intervention group received the 4-week stroke self-management program. The control group received usual care. All participants were assessed at baseline and 8 weeks after randomization. Data were analyzed using generalized estimating equations. Outcomes included self-efficacy, outcome expectation, and satisfaction with performance of self-management behaviors. One hundred twenty-eight participants were randomized with mean age, 67.46 years (SD, 11.95); 59% men; and mean duration poststroke, 45 days (SD, 26.16). At 8 weeks of follow-up in the intention-to-treat population, the intervention group improved significantly in self-efficacy (95% confidence interval, 2.55-12.45; P<0.01), outcome expectation (95% confidence interval, 5.47-14.01; P<0.01), and satisfaction with performance of self-management behaviors (95% confidence interval, 3.38-13.87; P<0.01) compared with the control. Similar results were obtained at 8 weeks of follow-up in the per-protocol population. The stroke self-management program improved survivors' self-efficacy, outcome expectation, and satisfaction with performance of self-management behaviors. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02112955.

Abstract 45: A Stroke Self-Management Program to Enhance Self-Efficacy and Outcome Expectation: A Randomized Controlled Trial

Introduction: Evidence has shown maintaining stroke survivors’ confidence and supporting their self-management after discharge were associated with improved stroke recovery. Aim: To test in a randomized controlled trial whether a self-efficacy and outcome expectation enhancing stroke self-management program improved health outcomes. Methods: Eligible adult survivors recruited from three acute stroke units were randomized to a new 4-week stroke self-management program (SESSMP) or usual care. The program, underpinned by Bandura’s constructs of self-efficacy and outcome expectation, offered home visits, community group sessions and follow-up phone calls. Primary outcomes included self-efficacy and outcome expectation of self-management. Secondary outcomes included satisfaction with performance of self-management behaviors, health-related quality of life (HRQoL), depressive symptoms and community reintegration. Differential changes of outcomes from baseline to 8-weeks follow-up (one-month post-program) between the two groups were evaluated by generalized estimating equations. Results: We recruited 128 participants (mean age 67.46 years, SD 11.95). The SESSMP group in the intention-to-treat (ITT) population showed significantly greater improvements in primary and secondary outcomes except depressive symptoms than the control group across time. Analyses of ITT and per-protocol populations found the changes in scores of all primary and secondary outcomes across time between the two groups comparable. Those receiving all sessions had the greatest and significant increase in self-efficacy, outcome expectation and HRQoL across time compared to those completing only part of the SESSMP and to the control group. No program-related adverse effects were reported. Majority receiving the SESSMP found home visits by nurses and videos about stroke volunteers’ recovery experiences most helpful. Conclusions: The results suggested the SESSMP improved survivors’ confidence, positive expectations, self-management behaviors, HRQoL and social outcomes.

Abstract TMP46: Stroke Self-management Effectiveness Trial

Given the lack of patient-centered, self-care programs after stroke, we designed a stroke self-management program based upon social cognitive theory and stakeholder input. Objectives: We conducted a randomized controlled trial to evaluate the effectiveness of the program after stroke on stroke specific, quality of life, SSQOL, and maintenance at 1 year. Methods: We enrolled 258 participants within 90 days of a stroke, on average, stratified by stroke, n=218, or TIA, n=40, and by VA and nonVA healthcare systems. The program included telephone case management, support groups, and booster calls. Outcomes of SSQoL, PHQ9, self-efficacy were assessed at 0, 3, 6, and 12 months. We compared the intervention to usual care using linear mixed effects modeling. Results: We delivered the program with high fidelity: 16/19 elements were delivered to &gt; 90%. Our sample included 19% women with an average age of 61.7 years with an average NIHSS=3. At 3 months, the groups did not differ. However, at 6 months, we report an adjusted intervention effect on mean change in total SSQoL, m=0.30, compared to usual care m=0.16, p&lt; 0.05. We found a significant interaction effect, p&lt;0.01, on the total SSQoL changes across the categories of the NIHSS stroke severity. We saw the largest change in the minor stroke impairment group. Moreover, we found significant intervention effects on the self-efficacy to manage stroke health p&lt;0.04 and physical functioning domain, p&lt;0.03. At 12 months, the group differences were no longer significant. Conclusions: A stroke self-management program is effective for improving the health-related quality of life, self-efficacy to manage health and physical functioning of patients after an acute stroke during the first six months post discharge. Long term maintenance may need additional support and resources. Finally, our results remained significant after adjusting for the healthcare system, patient demographics and whether the acute event was a stroke or TIA. Thus, healthcare systems may consider implementing such programs as patients transition after the acute health event.