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Li R, Zhu D, Tan Z. The effects of self-management education on self-efficacy, self-esteem, and health behaviors among patients with stroke. Medicine (Baltimore) 2025; 104:e40758. [PMID: 39960955 PMCID: PMC11835134 DOI: 10.1097/md.0000000000040758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 11/12/2024] [Indexed: 02/20/2025] Open
Abstract
The concept of self-management has become one of the most critical concepts in stroke rehabilitation. This study examined the impact of a 2-week stroke self-management program on the self-efficacy, self-esteem, and health behaviors of stroke patients. This retrospective study was conducted from January 2022 to October 2022 with 116 patients who had been admitted to the hospital with a stroke diagnosis after admission to the hospital. This study had 4 primary outcomes: self-efficacy, self-esteem, and health behaviors. Each of those outcomes was assessed at baseline, postintervention, and 1 month postintervention. Fifty-one participants were enrolled in the intervention group and 49 participants were enrolled in the control group. According to the baseline data, there was no significant difference between the 2 groups regarding demographics, clinical characteristics, self-efficacy, self-esteem, and health behaviors of participants (P > .05). Moreover, the difference between the mean scores of self-efficacy, self-esteem, and health behaviors between the 3 measurement time points was not significant (P > .05) in the control group, but there were considerable differences between the mean scores of all 3 factors in the intervention group (P < .05). A significant difference was observed between the groups in terms of self-efficacy, self-esteem, and health behaviors after the educational program (P < .05). Patients with stroke can significantly improve their self-efficacy, self-esteem, and health behaviors as a result of self-management education.
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Affiliation(s)
- Runping Li
- Department of Encephalopathy, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Dan Zhu
- Department of Bone Traumatology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Zhiwen Tan
- Department of Encephalopathy, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
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Lei Y, Li Z, Bui Q, DePaul O, Nicol GE, Mohr DC, Fong MWM, Metts CL, Lee SI, Tomazin SE, Wong AWK. Satisfaction, user experiences, and initial efficacy of a technology-supported self-management intervention (iSMART) to improve post-stroke functioning: a remoted randomized controlled trial. Top Stroke Rehabil 2025:1-15. [PMID: 39792597 DOI: 10.1080/10749357.2025.2450950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 01/05/2025] [Indexed: 01/12/2025]
Abstract
BACKGROUND Self-management interventions empower individuals to manage their chronic conditions and daily life after stroke. However, traditional in-person self-management interventions often face transportation and geographical barriers. Digital interventions may offer a solution to address this gap. OBJECTIVES This pilot randomized controlled trial (RCT) aimed to examine treatment satisfaction, user experiences, and the initial effect of the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention in stroke survivors to improve post-stroke functioning. METHODS Participants (N = 24) with mild-to-moderate chronic stroke completed a parallel, 2-arm, nonblinded, remote RCT. They were randomly assigned to either a 12-week iSMART or a control intervention (post-stroke information). iSMART was a technology-based self-management intervention involving skill-building education, human coaching, and text messaging. Participants completed a battery measuring treatment satisfaction, use experiences, and function and participation outcomes at baseline and post-intervention. RESULTS iSMART participants expressed greater satisfaction with their treatment (r = 0.387), healthcare environment (r = 0.454), relationships with providers (r = 0.374), and higher expectations for positive treatment outcomes (r = 0.328) than control participants, with medium effect sizes. The iSMART group rated the overall program and its coaching, skill-building, and text messaging components as helpful. iSMART participants showed a medium effect in improving overall post-stroke functioning, but control participants showed a small effect. Moreover, iSMART participants showed moderate-to-large effects in improving hand function (r = 0.699), mobility (r = 0.499), memory and thinking (r = 0.436), communication (r = 0.416), social participation (r = 0.307), community reintegration (r = 0.652), and perceived recovery (r = 0.545). CONCLUSIONS Our results provide initial evidence that iSMART supports stroke survivors in managing chronic conditions and enhancing post-stroke functioning.
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Affiliation(s)
- Yating Lei
- Department of Occupational Therapy, New York University, New York, NY, USA
| | - Zhaoying Li
- Division of Occupational Science and Occupational Therapy, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Quoc Bui
- Internal Medicine Residency Program, South Texas Health System, GME Consortium, Edinburg, TX, USA
| | - Olivia DePaul
- Memorial Hospital Belleville, BJC HealthCare, Belleville, IL, USA
| | - Ginger E Nicol
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Sunghoon I Lee
- Manning College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Stephanie E Tomazin
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wan X, Chan DNS, Chau JPC, Zhang Y, Liao Y, Zhu P, Choi KC. Effects of a nurse-led peer support intervention on psychosocial outcomes of stroke survivors: A randomised controlled trial. Int J Nurs Stud 2024; 160:104892. [PMID: 39303644 DOI: 10.1016/j.ijnurstu.2024.104892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Living with stroke poses many psychosocial challenges. Interventions for improving stroke survivors' psychosocial outcomes are lacking. Peer support interventions may contribute to recovery after stroke. However, current evidence is insufficient to suggest their application in enhancing stroke survivors' psychosocial well-being. OBJECTIVE This study aimed to evaluate the effectiveness of a nurse-led peer support intervention for improving the psychosocial outcomes of stroke survivors. DESIGN An assessor-blinded two-arm randomised controlled trial with an attention control group. SETTINGS A community health centre and a rehabilitation unit in Yangzhou, China. PARTICIPANTS First-ever or recurrent ischaemic or haemorrhagic stroke survivors. METHODS A convenience sample of 120 stroke survivors was recruited with 60 participants randomly assigned to each of the intervention and control groups. Intervention group participants received the nurse-led peer support intervention. Control group participants received attention care. The primary outcomes were social participation and participation self-efficacy. The secondary outcomes were psychological distress, perceived social support, stigma towards diseases, and quality of life. Data were collected at baseline (T0), immediately post-intervention (T1) and three months post-intervention (T2). Generalised estimating equations models were used to determine the effects of the intervention on the outcomes. RESULTS The intervention significantly improved social participation (T1: adjusted mean difference = -18.45, 95 % CI: -22.89 to -14.01, p < 0.001; T2: adjusted mean difference = -14.71, 95 % CI: -22.36 to -7.05, p < 0.001), participation self-efficacy (T1: adjusted mean difference = 47.92, 95 % CI: 37.56 to 58.27, p < 0.001; T2: adjusted mean difference = 39.58, 95 % CI: 17.88 to 61.28, p < 0.001) and perceived social support (T1: adjusted mean difference = 7.56, 95 % CI: 4.93 to 10.19, p < 0.001; T2: adjusted mean difference = 7.41, 95 % CI: 4.01 to 10.80, p < 0.001), and reduced psychological distress (T1: adjusted mean difference = -4.97, 95 % CI: -6.25 to -3.69, p < 0.001; T2: adjusted mean difference = -4.67, 95 % CI: -6.24 to -3.11, p < 0.001) and stigma towards diseases (T1: adjusted mean difference = -3.83, 95 % CI: -5.14 to -2.51, p < 0.001; T2: adjusted mean difference = -3.19, 95 % CI: -5.20 to -1.19, p < 0.001) at both T1 and T2. The intervention significantly improved quality of life at T1 only (adjusted mean difference = 0.12, 95 % CI: 0.06 to 0.19, p = 0.02). CONCLUSIONS The results provide empirical support for the effectiveness of the nurse-led peer support intervention in improving the psychosocial outcomes of stroke survivors and provide additional evidence to support their inclusion in stroke rehabilitation. REGISTRATION ChiCTR.org.cn (ChiCTR2100050853), Start of recruitment: October 2021.
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Affiliation(s)
- Xiaojuan Wan
- School of Nursing, Yangzhou University, 136#, Hanjiang Middle Road, Yangzhou, Jiangsu Province, China
| | - Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong, China.
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong, China
| | - Yu Zhang
- School of Nursing, Yangzhou University, 136#, Hanjiang Middle Road, Yangzhou, Jiangsu Province, China
| | - Yuexia Liao
- School of Nursing, Yangzhou University, 136#, Hanjiang Middle Road, Yangzhou, Jiangsu Province, China
| | - Pinting Zhu
- School of Nursing, Yangzhou University, 136#, Hanjiang Middle Road, Yangzhou, Jiangsu Province, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong, China
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Kotzur C, Patterson F, Harrington R, Went S, Froude E. Therapeutic groups run for community-dwelling people with acquired brain injury: a scoping review. Disabil Rehabil 2024; 46:4860-4876. [PMID: 37975242 DOI: 10.1080/09638288.2023.2283099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Therapeutic group interventions are commonly provided in acquired brain injury (ABI) inpatient rehabilitation settings, but little is known about the extent of therapeutic groups run for community-dwellers with ABI. This paper seeks to review current literature concerning the nature of therapeutic groups run for community-dwellers with ABI and the involvement of occupational therapists. MATERIALS & METHODS A scoping review was conducted with systematic searching of relevant databases guided by Arksey and O'Malley's framework. Studies were included if they reported on therapeutic groups for community-dwellers with ABI. Articles were collated and summarised with key findings presented in narrative form with accompanying tables. RESULTS Seventy articles met inclusion. Groups are used as therapeutic change agents for community-dwellers with ABI and target a diverse range of participation barriers. Participants valued group programs that established safe environments, a sense of belonging, growth opportunities and social connections. Group accessibility needs to be improved, with better funding avenues available for service providers, as well as greater consumer involvement in group design and facilitation. CONCLUSIONS Groups are a valuable therapeutic modality supporting community-dwellers with ABI. Further research is warranted into the use of groups by occupational therapists working with community-dwellers with ABI.
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Affiliation(s)
- Cheryl Kotzur
- School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - Freyr Patterson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rosamund Harrington
- School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - Samantha Went
- School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - Elspeth Froude
- School of Allied Health, Australian Catholic University, Sydney, Australia
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Bass JD, Marchant JK, de Sam Lazaro SL, Baum CM. Application of the Person-Environment-Occupation-Performance Model: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:521-540. [PMID: 38519867 PMCID: PMC11180417 DOI: 10.1177/15394492241238951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
The Person-Environment-Occupation-Performance (PEOP) Model is one of several occupation-based models in occupational therapy. The model describes the transactional nature of person, environment, and occupation factors that support performance (doing), participation (engagement), and well-being (health and quality of life). The purpose of this study was to explore the extent and nature of evidence on the PEOP Model. We used a scoping review to identify and analyze journal articles that used the PEOP Model as a framework for study. The PRISMA extension for scoping reviews (PRISMA-ScR) criteria were used to develop the research methods. We found 109 articles that adopted the PEOP Model as an organizing framework. The studies reviewed represent the breadth of occupational therapy practice and the transactional nature of person, environment, occupation, and performance in the PEOP Model. The PEOP Model is a useful international framework for research and practice across populations, conditions, life circumstances, settings, and areas of practice.
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An Z, Li K, Yang X, Ke J, Xu Y, Zhang X, Meng X, Luo X, Yu L. Community-based rehabilitation services implemented by multidisciplinary teams among adults with stroke: a scoping review with a focus on Chinese experience. BMC Public Health 2024; 24:740. [PMID: 38454384 PMCID: PMC10921794 DOI: 10.1186/s12889-024-18218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Despite the growing interest in hospital rehabilitation services for communities, studies on existing community-based rehabilitation (CBR) services remain scarce owing to limitations in the development of community health services and regional cultural diversity. As a guaranteed measure for ensuring the quality of rehabilitation services and achieving the desired service outcomes, clear roles and responsibilities in multidisciplinary teams and effective service delivery are particularly important. OBJECTIVE This scoping review aimed to determine the scope of community stroke rehabilitation programs involving existing multidisciplinary teams and to analyze the implementation content and implementers' functional roles to provide guidance for future CBR programs. METHODS The scoping review design followed the methodology of the Joanna Briggs Institute and was based on the normative scoping review framework proposed by Arksey and O'Malley. The comprehensive CBR framework was proposed by World Health Organization-guided data charting and analysis. RESULTS Of the 22,849 identified citations, 74 studies were included, consisting of 6,809 patients with stroke and 49 primary caregivers, most of whom were from China. The most common working mode in CBR programs was a dual approach involving both healthcare professionals in medical institutions and community healthcare professionals. The number of programs in each discipline was in the following descending order: nursing, medical care, rehabilitation, psychology, nutrition, and public health. Among these, multidisciplinary teams comprising medical, nursing, and rehabilitation disciplines were the most common, with a total of 29 programs. Disciplinary members were mainly responsible for implementing their respective disciplinary content, with physicians providing guidance for the programs. More than 82.4% of the studies reported 2-4 intervention strategies. The intervention forms of rehabilitation content were the most diverse, whereas preventive interventions were more homogeneous than others. Physical function and socio-psychological measurements were the most commonly reported outcomes. CONCLUSION CBR services implemented by multidisciplinary teams can effectively achieve functional and emotional improvement in patients with stroke, and nurses are the most involved in implementation, especially in community settings. The results further emphasize the importance of strengthening the exploration of nurses' maximum potential to implement CBR plans in future practice. TRIAL REGISTRATION The registration information for this scoping review can be found at osf.io/pv7tg.
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Affiliation(s)
- Zifen An
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Ke Li
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Xinyi Yang
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Jie Ke
- Department of General Practice, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Yuying Xu
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Xi Zhang
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Xianmei Meng
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China.
- Department of General Practice, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, 430071, Wuhan, Hubei Province, China.
| | - Xianwu Luo
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China.
| | - Liping Yu
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China.
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Li Z, Lei Y, Bui Q, DePaul O, Nicol GE, Mohr DC, Lee SI, Fong MWM, Metts CL, Tomazin SE, Wong AWK. A Digital Intervention to Promote Self-Management Self-Efficacy Among Community-Dwelling Individuals With Stroke: Pilot Randomized Controlled Trial. JMIR Rehabil Assist Technol 2024; 11:e50863. [PMID: 38373029 PMCID: PMC10912984 DOI: 10.2196/50863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Digital interventions provided through smartphones or the internet that are guided by a coach have been proposed as promising solutions to support the self-management of chronic conditions. However, digital intervention for poststroke self-management is limited; we developed the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention to address this gap. OBJECTIVE This study aimed to examine the feasibility and initial effects of the iSMART intervention to improve self-management self-efficacy in people with stroke. METHODS A parallel, 2-arm, nonblinded, randomized controlled trial of 12-week duration was conducted. A total of 24 participants with mild-to-moderate chronic stroke were randomized to receive either the iSMART intervention or a manual of stroke rehabilitation (attention control). iSMART was a coach-guided, technology-supported self-management intervention designed to support people managing chronic conditions and maintaining active participation in daily life after stroke. Feasibility measures included retention and engagement rates in the iSMART group. For both the iSMART intervention and active control groups, we used the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure to assess the feasibility, acceptability, and appropriateness, respectively. Health measures included the Participation Strategies Self-Efficacy Scale and the Patient-Reported Outcomes Measurement Information System's Self-Efficacy for Managing Chronic Conditions. RESULTS The retention rate was 82% (9/11), and the engagement (SMS text message response) rate was 78% for the iSMART group. Mean scores of the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure were 4.11 (SD 0.61), 4.44 (SD 0.73), and 4.36 (SD 0.70), respectively, which exceeded our benchmark (4 out of 5), suggesting high feasibility, acceptability, and appropriateness of iSMART. The iSMART group showed moderate-to-large effects in improving self-efficacy in managing emotions (r=0.494), symptoms (r=0.514), daily activities (r=0.593), and treatments and medications (r=0.870), but the control group showed negligible-to-small effects in decreasing self-efficacy in managing emotions (r=0.252), symptoms (r=0.262), daily activities (r=0.136), and treatments and medications (r=0.049). In addition, the iSMART group showed moderate-to-large effects of increasing the use of participation strategies for management in the home (r=0.554), work (r=0.633), community (r=0.673), and communication activities (r=0.476). In contrast, the control group showed small-to-large effects of decreasing the use of participation strategies for management in the home (r=0.567), work (r=0.342, community (r=0.215), and communication activities (r=0.379). CONCLUSIONS Our findings support the idea that iSMART was feasible to improve poststroke self-management self-efficacy. Our results also support using a low-cost solution, such as SMS text messaging, to supplement traditional therapeutic patient education interventions. Further evaluation with a larger sample of participants is still needed. TRIAL REGISTRATION ClinicalTrials.gov 202004137; https://clinicaltrials.gov/study/NCT04743037?id=202004137&rank=1.
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Affiliation(s)
- Zhaoying Li
- Division of Occupational Science and Occupational Therapy, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Yating Lei
- Department of Occupational Therapy, New York University, New York, NY, United States
| | - Quoc Bui
- Institute for Informatics, Data Science & Biostatistics, Washington University School of Medicine, St. Louis, MO, United States
| | - Olivia DePaul
- Memorial Hospital Belleville, Belleville, IL, United States
| | - Ginger E Nicol
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - David C Mohr
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sunghoon I Lee
- Manning College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Mandy W M Fong
- Michigan Avenue Neuropsychologists, Chicago, IL, United States
| | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Stephanie E Tomazin
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Egan M, Kessler D, Gurgel-Juarez N, Chopra A, Linkewich E, Sikora L, Montgomery P, Duong P. Stroke rehabilitation adaptive approaches: A theory-focused scoping review. Scand J Occup Ther 2024; 31:1-13. [PMID: 37976402 DOI: 10.1080/11038128.2023.2257228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Stroke rehabilitation consists of restorative and adaptive approaches. Multiple adaptive approaches exist. AIMS/OBJECTIVES The objective of this study was to develop a framework for categorising adaptive stroke rehabilitation interventions, based on underlying theory. MATERIAL AND METHODS We searched multiple databases to April 2020 to identify studies of interventions designed to improve participation in valued activities. We extracted the name of the intervention, underlying explicit or implicit theory, intervention elements, and anticipated outcomes. Using this information, we proposed distinct groups of interventions based on theoretical drivers. RESULTS Twenty-nine adaptive interventions were examined in at least one of 77 studies. Underlying theories included Cognitive Learning Theory, Self-determination Theory, Social Cognitive Theory, adult learning theories, and Psychological Stress and Coping Theory. Three overarching theoretical drivers were identified: learning, motivation, and coping. CONCLUSIONS At least 29 adaptive approaches exist, but each appear to be based on one of three underlying theoretical drivers. Consideration of effectiveness of these approaches by theoretical driver could help indicate underlying mechanisms and essential elements of effective adaptive approaches. SIGNIFICANCE Our framework is an important advance in understanding and evaluating adaptive approaches to stroke rehabilitation.
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Affiliation(s)
- Mary Egan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Dorothy Kessler
- School of Rehabilitation Therapy, Queens University, Kingston, ON, Canada
| | | | - Anchal Chopra
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | | | - Patrick Duong
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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Dobe J, Gustafsson L, Walder K, Bower K, Lachman R. Co-creation of self-management support during inpatient stroke rehabilitation. PEC INNOVATION 2023; 3:100191. [PMID: 37521957 PMCID: PMC10371841 DOI: 10.1016/j.pecinn.2023.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/04/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023]
Abstract
Objective This study aimed to identify priority self-management skills and behaviours in partnership with stroke survivors, and to co-create approaches to support self-management during inpatient stroke rehabilitation. Methods Three stroke survivors and two communication partners participated in the three-stage Participatory Action Research project with embedded co-design processes after undertaking inpatient rehabilitation at a metropolitan tertiary hospital. Results Participants identified key factors influencing self-management during inpatient rehabilitation including motivation, emotional well-being, and fatigue. Three approaches to support people to self-manage post-stroke were co-created. (1) A health professional concierge and early family meeting. (2) A peer support person. (3) Adapting the hospital environment. Conclusion Findings suggest post-stroke self-management support should commence during inpatient rehabilitation to optimise its research-informed benefits. This support should focus on empowering stroke survivors and their key support people through active involvement in decision-making, and provision of multi-modal individualised education. The impact of hospital environments on emotional-wellbeing and self-management post-stroke also requires further investigation. Innovation The identification of a health professional concierge as a co-designed solution to the current challenges with self-management support is an innovative recommendation for practice. The findings support changes to the traditional processes of rehabilitation towards a consumer and family-led practices.
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Affiliation(s)
- Joshua Dobe
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Queensland, Australia
| | - Kim Walder
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
| | - Kylie Bower
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
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10
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Zhang Q, Chen S, Zhang Y, Ni J, Huang J, Wu Y, Li M. Interventions targeting psychosocial adaptation in people with stroke: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 113:107751. [PMID: 37116222 DOI: 10.1016/j.pec.2023.107751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This scoping review aimed to describe and map interventions targeting psychosocial adaptation in people with stroke. METHODS A scoping review was conducted using the Joanna Briggs Institute methodology and reported according to Systematic Review and Meta-Analyses Extension for Scoping Reviews guidelines. We included original studies with interventions targeting psychosocial adaptation (concept) on people with stroke (population) in any setting (context). We searched five online electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Cochrane Central Registry of Controlled Trials). We described interventions in terms of design characteristics, theoretical basis, details of interventions, and quantitative outcomes indicated in psychosocial adaptation. RESULTS Forty-three studies were identified. Five intervention categories were identified to describe the interventions targeting psychosocial adaptation. Quantitative outcomes indicated psychosocial adaptation in our review were grouped into four domains: global adaptation, psychological adaptation, social adaptation, and others. CONCLUSIONS The mapping and description brought to light the large heterogeneity of interventions targeting psychosocial adaptation in people with stroke. PRACTICE IMPLICATIONS Deepening understanding of psychosocial adaptation can help health professionals further develop effective interventions aiming at promoting psychosocial adaptation and reducing negative health sequelae, such as risk of reduced psychosomatic recovery post stroke.
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Affiliation(s)
- Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Shanshan Chen
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Jieqing Ni
- School of Social Sciences in Applied Psychology, Lingnan University, Hong Kong, China
| | - Jing Huang
- School of Nursing, Peking University, Beijing, China
| | - Yi Wu
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China.
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The Effect of Self-Care Nurturance Using the Theory of Modeling and Role-Modeling on Self-Efficacy in Stroke Patients: A Randomized Controlled Trial. Holist Nurs Pract 2023; 37:E24-E35. [PMID: 36790426 DOI: 10.1097/hnp.0000000000000567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The disability after a stroke results in reduced self-care capacity and lower levels of self-efficacy in survivors. Exploiting a holistic self-care plan to strengthen internal resources in clients can be thus deemed as an effective solution. This study aimed to determine the effect of self-care nurturance using the Theory of Modeling/Role-Modeling (TMRM) on self-efficacy in stroke clients. A randomized controlled trial was conducted at Qaem Hospital, Mashhad, Iran, in 2020. For this purpose, 70 clients were randomly assigned to 2 groups. Then, the experimental group received self-care nurturance based on the TMRM, all through 4 to 6 individual sessions of 30 to 45 minutes in the hospital, and subsequently 2 sessions of telephone counseling up to 8 weeks after the discharge. With reference to patient evaluation in terms of self-care resources, knowledge, and actions, the researcher also tried to strengthen such factors based on the individual needs of each client. The control group received routine care. The data were collected through completing a demographic/disease information form at the onset and the Stroke Self-Efficacy Questionnaire (SSEQ) before the intervention, 4 and 8 weeks after it. The results revealed that the self-efficacy mean scores of the experimental group, in the course of 3 measurement stages, had significantly improved, compared with that in the control group (P = .018). It was concluded that applying the TMRM could strengthen internal and external resources and self-care knowledge in stroke patients, develop their self-care actions, and improve their levels of self-efficacy.
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Effects of mobile phone App-based continuing nursing care on self-efficacy, quality of life, and motor function of stroke patients in the community. Acta Neurol Belg 2023; 123:107-114. [PMID: 33728581 DOI: 10.1007/s13760-021-01628-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022]
Abstract
To explore the effects of mobile phone application (App)-based continuing nursing care on the self-efficacy (SE), quality of life (QOF), and motor function (MF) of stroke patients in the community. A total of 101 stroke patients in the community recruited in this study for retrospective analysis were divided into a control group (CG) and an observation group (OG) based on the means of intervention. In total, 50 patients in the CG received routine community health education, based on which a mobile phone App-based continuing nursing mode was applied to the 51 patients in the OG. Changes in physiological indicators, including homocysteine (Hcy), high-density lipoprotein (HDL-C), and total cholesterol (TC), were evaluated before and after intervention. Moreover, MF [determined using the Fugal-Meyer motor function assessment (FMA)], SE (determined using stroke self-efficacy questionnaire), QOF, and satisfaction toward nursing were evaluated. (1) Hcy and TC levels in the OG were lower after intervention; however, HDL-C levels were higher than those in the CG, with statistically significant differences (P < 0.05). (2) The FMA MF of the upper and lower limb (FMA-U and FMA-L) scores and the total scores in the OG after the intervention were significantly improved compared with those in the CG (P < 0.05). (3) Patients in the OG showed significantly higher SE scores than those in the CG (P < 0.05). (4) Scores of emotional health, emotional function, social function, energy, general health status, body pain, physiological function, and physiological features were significantly higher in the OG than those in the CG after the intervention (P < 0.05). (5) Patients in the OG expressed more positive satisfaction toward nursing than those in the CG, with statistically significant differences (P < 0.05). Mobile phone App-based continuing nursing care may significantly improve the SE, quality of life, and satisfaction toward nursing as well as promote the improvement of biological markers and MF of stroke patients.
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Lucas Molitor W, Feldhacker DR, Lohman H, Lampe AM, Jensen L. Occupational Therapy and the IMPACT Act: Part 1. A Systematic Review of Evidence for Fall Prevention and Reduction, Community Discharge and Reintegration, and Readmission Prevention Interventions. Am J Occup Ther 2022; 76:23116. [PMID: 34962516 DOI: 10.5014/ajot.121.049044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing costs. OBJECTIVE In this systematic review, we address three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission. DATA SOURCES We conducted a search of the literature published between 2009 and 2019. Study Selection and Data Collection: We developed operational definitions to help us identify articles that answered the search question for each outcome area. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS We found 53 articles that address the three outcome areas. Regarding the prevention and reduction of falls, low strength of evidence is available for interventions focusing on a single fall risk and for customized interventions addressing multiple risks. Moderate strength of evidence supports structured community fall risk prevention interventions. Low strength of evidence was found for community discharge and reintegration interventions that include physical activity and educational programming. Low to moderate strength of evidence was found for readmission prevention interventions for patients with four types of condition. Conclusion and Relevance: Several intervention themes in the three outcome areas of interest are supported by few studies or by studies with a moderate risk of bias. Additional research is needed that supports the value of occupational therapy interventions in these outcome areas. What This Article Adds: Our study provides important insights into the state of the evidence related to occupational therapy interventions to address three outcome areas of the IMPACT Act.
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Affiliation(s)
- Whitney Lucas Molitor
- Whitney Lucas Molitor, PhD, OTD, OTR/L, BCG, is Assistant Professor, Department of Occupational Therapy, and Undergraduate Public Health Program Director, University of South Dakota, Vermillion;
| | - Diana R Feldhacker
- Diana R. Feldhacker, OTD, OTR/L, BCPR, is Department Chair, Program Director, and Assistant Professor, Department of Occupational Therapy, Des Moines University, Des Moines, IA
| | - Helene Lohman
- Helene Lohman, OTD, OTR/L, is Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Angela M Lampe
- Angela M. Lampe, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Lou Jensen
- Lou Jensen, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
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Lucas Molitor W, Feldhacker DR, Lohman H, Lampe AM, Jensen L. Occupational Therapy and the IMPACT Act: Part 1. A Systematic Review of Evidence for Fall Prevention and Reduction, Community Discharge and Reintegration, and Readmission Prevention Interventions. Am J Occup Ther 2022; 76:23123. [PMID: 34967846 DOI: 10.5014/ajot.2022.049044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing costs. OBJECTIVE In this systematic review, we address three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission. DATA SOURCES We conducted a search of the literature published between 2009 and 2019. Study Selection and Data Collection: We developed operational definitions to help us identify articles that answered the search question for each outcome area. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS We found 53 articles that address the three outcome areas. Regarding the prevention and reduction of falls, low strength of evidence is available for interventions focusing on a single fall risk and for customized interventions addressing multiple risks. Moderate strength of evidence supports structured community fall risk prevention interventions. Low strength of evidence was found for community discharge and reintegration interventions that include physical activity and educational programming. Low to moderate strength of evidence was found for readmission prevention interventions for patients with four types of condition. Conclusion and Relevance: Several intervention themes in the three outcome areas of interest are supported by few studies or by studies with a moderate risk of bias. Additional research is needed that supports the value of occupational therapy interventions in these outcome areas. What This Article Adds: Our study provides important insights into the state of the evidence related to occupational therapy interventions to address three outcome areas of the IMPACT Act.
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Affiliation(s)
- Whitney Lucas Molitor
- Whitney Lucas Molitor, PhD, OTD, OTR/L, BCG, is Assistant Professor, Department of Occupational Therapy, and Undergraduate Public Health Program Director, University of South Dakota, Vermillion;
| | - Diana R Feldhacker
- Diana R. Feldhacker, OTD, OTR/L, BCPR, is Department Chair, Program Director, and Assistant Professor, Department of Occupational Therapy, Des Moines University, Des Moines, IA
| | - Helene Lohman
- Helene Lohman, OTD, OTR/L, is Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Angela M Lampe
- Angela M. Lampe, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Lou Jensen
- Lou Jensen, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
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Wan X, Chau JPC, Mou H, Liu X. Effects of peer support interventions on physical and psychosocial outcomes among stroke survivors: A systematic review and meta-analysis. Int J Nurs Stud 2021; 121:104001. [PMID: 34246069 DOI: 10.1016/j.ijnurstu.2021.104001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND High level of unmet needs were reported by stroke survivors after hospital discharge. Peer support interventions may play a valuable role in the management of stroke, but the evidence is unclear. OBJECTIVES To determine the effects of peer support interventions on physical and psychosocial outcomes of stroke survivors; and to identify the key characteristics of peer support interventions for stroke survivors.cv DESIGN: A systematic review and meta-analysis. REVIEW METHODS Seven English databases and four Chinese databases were searched to identify eligible articles. Two reviewers screened the eligible studies, appraised the risk of bias, and extracted the data independently. Version 2 of the Cochrane risk-of-bias tool was used to evaluate the risk of bias for randomized controlled trials, while the Risk of Bias in Non-randomized Studies of Interventions tool was used for the quasi-experimental studies. The Grading of Recommendations Assessment, Development and Evaluation profiler Guideline Development Tool was used to assess the quality of evidence. Meta-analyses were conducted using Review Manager 5.3, and narrative analyses were performed when meta-analysis was inappropriate. RESULTS Eleven studies were included. Peer support interventions could improve the activities of daily living (MD = 15.53, 95% CI: 1.39 to 29.68; P = 0.03, I2 = 99%; very low quality of evidence), limb function, depression (SMD = -1.27, 95% CI: -2.18 to -0.36; P = 0.006, I2 = 91%; very low quality of evidence) and anxiety. Although pooled analysis showed that social participation (SMD= 0.74, 95% CI: 0.09 to 1.39; P = 0.03, I2 = 69%; low quality of evidence) and quality of life (SMD = 0.41, 95% CI: 0.09 to 0.73; P = 0.01, I2 = 0%; low quality of evidence) improved after peer support interventions, the studies which were not pooled due to insufficient data drew inconsistent results. CONCLUSIONS Stroke survivors may benefit from peer support interventions to improve their physical and psychological outcomes. The evidence about the impact of peer support interventions on social participation and quality of life is very uncertain. It should be noted that the quality of evidence ranged from very low to low, thus highlighting the need for more research of higher quality to substantiate these findings.
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Affiliation(s)
- Xiaojuan Wan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong SAR, China; School of Nursing, Yangzhou University, No.136 Hanjiang Middle Road, Yangzhou, Jiangsu Province, Mainland, China.
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong SAR, China.
| | - Huanyu Mou
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong SAR, China.
| | - Xu Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong SAR, China.
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Bohannon RW. Characterization of muscle strength using the strength domain of the stroke impact scale: An integrative review. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-210101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE: Muscle weakness is among the most common and obvious impairments in older adults and individuals with neurologic disorders. Although impairments in muscle strength are typically characterized using performance measures, the impairments have also been described using patient or observer-report. The objective of this review was to summarize literature describing use of a patient-report instrument, the Strength Domain (SD) of the Stroke Impact Scale (SIS), to grade strength impairments. METHODS: Peer-reviewed literature reporting SD scores for the SIS was identified using computerized searches of the CINAHL, PubMed, and Scopus databases followed by hand searches. Potentially relevant articles were then mined for data on the participants tested, the SIS version used, scores documented, and clinimetric properties reported. RESULTS: Sixty-five articles were judged appropriate based on inclusion and exclusion criteria. The articles involved more than 7000 residents of 22 countries. All articles focused on individuals with stroke (usually chronic), although one also included community-dwelling adults without stroke. The SIS version used was frequently unreported, but 3.0 was version most often specified. For articles reporting SD scale scores the mean ranged from 19.7 to 85.5. Construct (known groups, convergent, and discriminant) validity of the SD was supported by the literature as was its internal consistency and test-retest reliability. Responsiveness of the SD was evinced by numerous studies showing increases in SD scores with time or accompanying effective interventions. However, only one study indicated responsiveness using an anchor-based statistic. CONCLUSIONS: The SD of the SIS is a well-established and mostly clinimetrically sound patient-report measure of paretic limb strength among individuals with stroke. Its use with individuals with weakness accompanying aging or diagnoses other than stroke remains to be substantiated.
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Zera SM, Preissner K, Fischer H, Stoffel A. Cognitive orientation to daily occupation group in the adult day rehabilitation setting: A feasibility study. Br J Occup Ther 2021. [DOI: 10.1177/03080226211008713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The Cognitive Orientation to daily Occupational Performance (CO-OP) ApproachTM is a leading approach in occupational therapy. Implementing the CO-OP ApproachTM in a group format in day rehabilitation has not yet been explored. Method In day rehabilitation, a barrier to implementing the CO-OP ApproachTM is the group model. To address these challenges, this feasibility study involved the development, implementation, and evaluation of a CO-OP group for adults. Four patients participated in six group sessions. Pre- and post-measures included the Canadian Occupational Performance Measure (COPM) and the Assessment of Motor and Process Skills (AMPS). Subjective data were collected to reflect the participant’s experiences during the group. Results 80% of participants recruited completed the group. All participants demonstrated improvement in goals addressed within the group and goals not addressed within the group on the COPM. AMPS findings were inconclusive. Subjective findings indicated participants appreciated the group learning environment, valued the CO-OP process, were motivated to participate, and would have liked more groups. Conclusion To our knowledge, this is the first adult CO-OP group in a clinical setting. Results support the feasibility of a CO-OP group in day rehabilitation and the need for further examination of the effectiveness of this intervention.
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Affiliation(s)
- Sarah M Zera
- Occupational Therapy Program, Midwestern University, USA
| | - Kathy Preissner
- Occupational Therapy Program, University of Illinois at Chicago, USA
| | - Heidi Fischer
- Occupational Therapy Program, University of Illinois at Chicago, USA
| | - Ashley Stoffel
- Occupational Therapy Program, University of Illinois at Chicago, USA
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Lo SHS, Chau JPC, Choi KC, Shum EWC, Yeung JHM, Li SH. Promoting community reintegration using narratives and skills building for young adults with stroke: a protocol for a randomised controlled trial. BMC Neurol 2021; 21:3. [PMID: 33397316 PMCID: PMC7783975 DOI: 10.1186/s12883-020-02015-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke in adults aged between 18 and 64 years old is increasing significantly worldwide. Studies have reported that this group of young stroke survivors encounters enormous difficulties reintegrating into their social roles. Individualised discussions with healthcare professionals and learning from other survivors are imperative for them to reconstruct their identities after stroke. There is also great demand for community support during their chronic stage of recovery to help them rebuild life skills to promote reintegration. METHODS/DESIGN This is a randomised controlled trial to investigate the effects of a 24-week Narrative and Skills-building Intervention (NSI) on young stroke survivors' community reintegration and psychosocial outcomes. A total of 208 adults aged 18-64 years old with a first-ever or recurrent ischaemic or haemorrhagic stroke and have been discharged home will be recruited and randomly assigned to receive usual care or usual care with NSI. The NSI is grounded in Narrative Theory and Bandura's principles of Self-efficacy and Outcome Expectation, consisting of successive eight individual sessions over six months delivered by a trained facilitator (a registered nurse). Participants will be facilitated to narrate their survival experiences and rebuild core life skills. Videos of peer young stroke survivors' experiences of recovery will be provided. Outcomes including community reintegration, depressive symptoms, health-related quality of life, self-efficacy, outcome expectation and satisfaction with performance of self-management behaviours will be measured before (T0) and immediately after NSI (T1), then six (T2) and 12 months after NSI (T3). Generalised estimating equations models will be used to compare the differential changes in outcomes across time between the two groups. Focus group interviews will be conducted with the facilitator at T1 and with the participants in the intervention group at T1 and T3. DISCUSSION This study will evaluate the short and long-term effects of a theory-based NSI on young stroke survivors' community reintegration and establish a new model of community reintegration after stroke to inform future research. The results will also provide valuable evidence to develop clinical guidelines for young stroke survivors' community reintegration. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04560140 , registered on 23 September, 2020.
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Affiliation(s)
- Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | | | - Jonas Hon Ming Yeung
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong SAR, China
| | - Siu Hung Li
- Department of Medicine, North District Hospital, Hospital Authority, Hong Kong SAR, China
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Harel-Katz H, Adar T, Milman U, Carmeli E. Examining the feasibility and effectiveness of a culturally adapted participation-focused stroke self-management program in a day-rehabilitation setting: A randomized pilot study. Top Stroke Rehabil 2020; 27:577-589. [DOI: 10.1080/10749357.2020.1738676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hagit Harel-Katz
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tamar Adar
- Department of Family Medicine, Haifa and West Gallilee District, Clalit Health Services, Israel
| | - Uzi Milman
- Department of Family Medicine, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Eli Carmeli
- Faculty of Social Welfare and Health Sciences, Department of Physical Therapy, University of Haifa, Haifa, Israel
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