Effects of Chronic Care Model-based interventions on self-management, quality of life and patient satisfaction in patients with ischemic stroke: A single-blinded randomized controlled trial

eHealth Interventions of Health Literacy for Stroke Survivors: Systematic Review and Meta-Analysis

BACKGROUND

eHealth literacy interventions have emerged as a new approach in management of stroke survivors. Its effect on knowledge and clinical outcomes presents an inconsistent result in literature.

OBJECTIVES

We aim to evaluate the impact of eHealth interventions on health literacy, clinical metrics, adherence to healthy behaviors, stroke recurrence, mortality, and health-related quality of life in stroke survivors.

METHODS

We systematically searched six databases (PubMed, Cochrane Library, CINAHL, EMBASE, Web of Science, ProQuest) up to February 21, 2024, selecting articles that meet these criteria: (i) patients with stroke; (ii) intervention with education content; (iii) eHealth interventions included telehealth, mobile phone, internet or computer; (iv) randomized controlled trials. The mean differences (MD) and standardized mean differences (SMD) between groups were measured. Risk of bias was evaluated using the Cochrane tool.

RESULTS

From 16 studies involving 9646 participants, we observed that eHealth interventions significantly improved systolic blood pressure (MD = -2.78 mmHg, 95% confidence interval (CI) [-4.67 to -0.88], p = 0.004), medication adherence (SMD = 0.28, 95% CI [0.04 to 0.52], p = 0.023), and health-related quality of life (SMD = 0.21, 95% CI [0.04 to 0.37], p = 0.013). Meta-regression found that age modified the effect size of systolic blood pressure (p = 0.027). There was insufficient evidence to conclude effects on other outcomes. The quality of evidence was moderate. Outcome variation may be due to the diversity in eHealth intervention approaches. The limited number of studies precluded the subgroup analysis. More interactive interventions with longer follow-ups were more effective.

CONCLUSIONS

eHealth interventions may benefit stroke survivors in terms of blood pressure, medication adherence, and health-related quality of life.

IMPLICATIONS FOR NURSING POLICY

eHealth literacy interventions could be implemented to improve the management of stroke survivors, especially in the context of resource limitations.

TRIAL REGISTRATION

PROSPERO registration number: CRD42024502470.

Technology-Based Health Promotion Training Among Stroke Patients: A Randomized Controlled Trial

Stroke is a disease with a heavy social and familial care burden that can cause permanent brain damage, long-term disability, and/or death. This study aimed to determine the effect of technology-based health promotion training on the daily life activities, quality of life, and self-care of stroke patients. The study design was a Randomized Controlled Trial. The study sample included persons diagnosed with stroke diagnosed with stroke and were receiving inpatient treatment in the neurology clinic of a university hospital. The sample size was calculated as a total of 70 patients, 35 interventions and 35 controls. The intervention group patients received telephone-based education and follow-up grounded in Orem's Self-Care Theory over a 12-week period subsequent to their discharge. The educational content was divided into three distinct categories: self-care needs with regard to health deviations, developmental self-care needs, and universal self-care practices. Data were collected using the Montreal Cognitive Assessment Scale, the Katz Index of Independence in Activities of Daily Living, Stroke-Specific Quality of Life Scale, and the Exercise of Self-Care Agency Scale. The Independent Sample T-Test was used for intergroup comparisons, and the Dependent Sample T-Test was used for intragroup pre-test and post-test comparisons. Independent variables affecting the post-test scores, such as age and gender, were analyzed using the multiple linear regression model. The scale sub-dimension variables were compared using the multivariate analysis of variance test according to the groups. When compared with the control group patients after the training, it was determined that there was a statistically significant difference in the intervention group patients' mean scores for the Stroke-Specific Quality of Life Scale (t = 11.136, p = .001) and the Exercise of Self-Care Agency Scale (t = 14.358, p = .000). Training interventions led to enhanced awareness and knowledge about stroke among the intervention group patients. They also fostered the development of healthier lifestyle behaviors and bolstered both self-care abilities and quality of life.

Effectiveness of self-management interventions during the peri-hospitalization period in patients with stroke: A systematic review and meta-analysis

OBJECTIVE

To synthesize the evidence of the effectiveness of self-management interventions during the peri-hospitalization period.

DATA SOURCES

Three databases (i.e. PubMed, Web of Science, and Scopus) were systematically searched.

REVIEW METHODS

Full-text randomized controlled studies that assessed the effects of self-management interventions initiated during the peri-hospitalization period in patients with stroke were included. Two independent reviewers performed data extraction. A third reviewer was available for discrepancies. The methodological quality was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2). Data were pooled and a meta-analysis was performed.

RESULTS

Eight studies comprising 1030 participants were included. The self-management interventions showed considerable heterogeneity in their protocols, although most of them included an individualized plan based on the patient's needs. The meta-analysis was performed with data from the self-efficacy domains. The pooled results showed a trend towards the self-management intervention on quality of life (1.07, 95% confidence interval [CI] 0.52 to 1.63; P = 0.0002) but neither in dependence (0.80, 95% CI -0.14 to 1.74; P = 0.10) nor in self-efficacy (0.77, 95% CI -0.44 to 1.98; P = 0.21).

CONCLUSION

Most of the studies reviewed suggest that self-management interventions had an impact on dependency, quality of life and self-efficacy when compared with usual care, written materials about stroke, or post-discharge rehabilitation recommended by a physician. However, the evidence in this review neither supports nor refutes self-management interventions used in addition to usual care, or other interventions, to improve dependency, quality of life and/or self-efficacy in patients' post-stroke.

Interventions for improving psychosocial well-being after stroke: A systematic review

BACKGROUND

Up to one third of all stroke patients suffer from one or more psychosocial impairments. Recognition and treatment of these impairments are essential in improving psychosocial well-being after stroke. Although nurses are ideally positioned to address psychosocial well-being, they often feel insecure about providing the needed psychosocial care. Therefore, we expect that providing nurses with better knowledge to deliver this care could lead to an improvement in psychosocial well-being after stroke. Currently it is not known which interventions are effective and what aspects of these interventions are most effective to improve psychosocial well-being after stroke.

OBJECTIVE

To identify potentially effective interventions - and intervention components - which can be delivered by nurses to improve patients' psychosocial well-being after stroke.

METHODS

A systematic review and data synthesis of randomized controlled trials and quasi experimental studies was conducted. Papers were included according to the following criteria: 1) before-after design, 2) all types of stroke patients, 3) interventions that can be delivered by nurses, 4) the primary outcome(s) were psychosocial. PubMed, Embase, PsychInfo, CINAHL and Cochrane library were searched (August 2019-April 2022). Articles were selected based on title, abstract, full text and quality. Quality was assessed by using Joanna Briggs Institute checklists and a standardized data extraction form developed by Joanna Brigss Institute was used to extract the data.

RESULTS

In total 60 studies were included, of which 52 randomized controlled trials, three non-randomized controlled trials, four quasi-experimental studies, and one randomized cross-over study. Nineteen studies had a clear psychosocial content, twenty-nine a partly psychosocial content, and twelve no psychosocial content. Thirty-nine interventions that showed positive effects on psychosocial well-being after stroke were identified. Effective intervention topics were found to be mood, recovery, coping, emotions, consequences/problems after stroke, values and needs, risk factors and secondary prevention, self-management, and medication management. Active information and physical exercise were identified as effective methods of delivery.

DISCUSSION

The results suggest that interventions to improve psychosocial well-being should include the intervention topics and methods of delivery that were identified as effective. Since effectiveness of the intervention can depend on the interaction of intervention components, these interactions should be studied. Nurses and patients should be involved in the development of such interventions to ensure it can be used by nurses and will help improve patients' psychosocial well-being.

FUNDING AND REGISTRATION

This study was supported by the Taskforce for Applied Research SIA (RAAK.PUB04.010). This review was not registered.

Medication self-management interventions for persons with stroke: A scoping review

The use of multiple medications is common following a stroke for secondary prevention and management of co-occurring chronic conditions. Given the use of multiple medications post-stroke, optimizing medication self-management for this population is important. The objective of this scoping review was to identify and summarize what has been reported in the literature on interventions related to medication self-management for adults (aged 18+) with stroke. Electronic databases (Ovid Medline, Ovid Embase, EBSCO CINAHL, Ovid PsycINFO, Web of Science) and grey literature were searched to identify relevant articles. For inclusion, articles were required to include an adult population with stroke undergoing an intervention aimed at modifying or improving medication management that incorporated a component of self-management. Two independent reviewers screened the articles for inclusion. Data were extracted and summarized using descriptive content analysis. Of the 56 articles that met the inclusion criteria, the focus of most interventions was on improvement of secondary stroke prevention through risk factor management and lifestyle modifications. The majority of studies included medication self-management as a component of a broader intervention. Most interventions used both face-to-face interactions and technology for delivery. Behavioural outcomes, specifically medication adherence, were the most commonly targeted outcomes across the interventions. However, the majority of interventions did not specifically or holistically target medication self-management. There is an opportunity to better support medication self-management post-stroke by ensuring interventions are delivered across sectors or in the community, developing an understanding of the optimal frequency and duration of delivery, and qualitatively exploring experiences with the interventions to ensure ongoing improvement.

A WeChat-based caregiver education program improves satisfaction of stroke patients and caregivers, also alleviates poststroke cognitive impairment and depression: A randomized, controlled study

Caregiver education program has been applied to stroke patients, while its effect on mental health in stroke patients is still obscure. This study aimed to assess the impact of the WeChat-based caregiver education (WBCE) program on cognition, anxiety, and depression in stroke patients. Totally, 170 patients with ischemic stroke were included. They were randomized at a 1:1 ratio to the WBCE group (N = 86) and control care (CC) group (N = 84), and their caregivers received WBCE or CC for 12 months, respectively. Mini-mental state examination (MMSE) score was increased in the WBCE group compared with that in the CC group at the 9th month (M9) (27.2 ± 1.9 vs 26.6 ± 1.6, P = 0.017) and M12 (27.1 ± 1.8 vs 26.5 ± 1.5, P = 0.015), while cognitive impairment rate was decreased in WBCE group compared with that in CC group at 12th month (M12) (30.2% vs 45.2%, P=0.043). In the meantime, the Hospital Anxiety and Depression Scale (HADS) for Anxiety score (6.5 ± 3.1 vs 7.5 ± 2.8, P = 0.020), HADS for depression score (6.7 ± 3.1 vs 7.7 ± 3.3, P = 0.040) and depression rate (33.7% vs 48.8%, P = 0.046) in WBCE group were reduced compared with those in CC group at M12. Besides, an elevation in the satisfaction score of patients at M12 (8.0 ± 1.2 vs 7.4 ± 1.2, P = 0.002) and that of caregivers at 6th months (M6) (6.6 ± 1.1 vs 6.2 ± 1.3, P = 0.038) and M12 (7.2 ± 1.1 vs 6.8 ± 1.4, P=0.042) were found in WBCE group compared with CC group. WBCE program not only improves the satisfaction of stroke patients and caregivers but also attenuates cognitive impairment and depression in stroke patients.

Improving Management of Non-communicable Chronic Diseases in Primary Healthcare Centres in The Saudi Health Care System

Evaluation of patient perceptions of quality and adequacy of care is a critical component of continuous improvement in chronic disease care. The purpose of this study was to ascertain how patients with non-communicable diseases (NCDs) assess their routine care in primary care centres in Saudi Arabia and to identify areas for improvement. This cross-sectional study used the PACIC questionnaire to assess the quality of care received by these patients in primary care centres in Saudi Arabia. Data collection took place between May 2019 and July 2019. The questionnaire was self-completed anonymously by 315 patients with NCD attending primary health care centres in Riyadh, Saudi Arabia. The results showed that the average overall PACIC score was 2.97 (SD = 0.65), the mean scores for the subscales ranged from 2.76 (SD = 0.78) for the subscale of goal settings/tailoring to 3.17 (SD = 0.78) for delivery system design/decision support. PACIC scores varied significantly with age, occupation, monthly income, type and duration of chronic illness and educational attainment. In conclusion, patients with NCDs prioritised improvements in organised care that; is comprehensive, focussed on their needs, helps them identify clear goals for their treatments and become more involved in their condition(s) management.