A systematic review of the effectiveness of stroke self-management programs for improving function and participation outcomes: self-management programs for stroke survivors

Acceptability of two mobile applications to support cross-sectoral, person-centred and empowering stroke rehabilitation - a process evaluation

AIM

To evaluate the acceptability of two co-designed mobile applications Mit Sygehus [a knowledge-based solution] and Genoptræn.dk [a self-training solution] to support a cross-sectoral, person-centred and empowering stroke rehabilitation.

SETTING

The applications were implemented and tested throughout two stroke rehabilitation trajectories in Southern Denmark, comprising two acute, two sub-acute and two municipal stroke rehabilitation settings.

METHODS, PARTICIPANTS AND ANALYSIS

A process evaluation focusing on acceptability was conducted. Individual and dyadic interviews were performed with ten stroke survivors (three women and seven men, aged 50-84) with moderate stroke and seven significant others (five women and two men, aged 50-78) post-rehabilitation. A constructivist Grounded Theory analysis was used to explore what, why, when, and how the apps worked or did not work throughout the stroke rehabilitation trajectory and if adaptions were needed.

RESULTS

Participants found that Mit Sygehus provided adequate and sufficient knowledge and was easy to use, however, acceptability of Mit Sygehus declined throughout the rehabilitation process. Also, knowledge on 'return-to-work' and 're-gaining driver's license/permission to drive' needed to be developed. The content in Genoptræn.dk was perceived as acceptable, through content being person-centred, motivating and meaningful. Genoptræn.dk furthermore, supported the transfer between rehabilitation settings, provided a sense of progress throughout the rehabilitation process, facilitated positive habits regarding self-training, and relieved the burden on significant others. Genoptræn.dk was perceived most acceptable in the sub-acute rehabilitation setting and declined when rehabilitation continued in the municipal setting.

CONCLUSION

Stroke survivors and their significant others found Mit Sygehus and Genoptræn.dk acceptable to support cross-sectoral, person-centred and empowering stroke rehabilitation, however acceptability declined throughout the rehabilitation process. Further investigations are required to determine how cognitive rehabilitation can play a greater role in app-supported stroke rehabilitation and how the need for more long-term follow-up can be supported.

Healthcare self-management support of stroke patients after discharge: A conceptual analysis using Rodger's evolutionary approach

AIM(S)

To explore the meaning of healthcare self-management support for post-discharged stroke patients.

METHOD

Rodgers' evolutionary approach was used to identify antecedents, attributes, related terms, surrogate terms and consequences.

DATA SOURCE

Literature from 2012 to 2022 was searched from MEDLINE, CINAHL, PsycINFO and Google Scholar.

RESULTS

Three antecedents preceded healthcare self-management support for post-discharged stroke patients: loss of inpatient support, preparedness for self-management and presence of self-management support. Healthcare self-management support for post-discharged stroke patients was defined by eight attributes: pre-discharge assessment and planning; provision of continuous education and training; collaborative goal-setting; reinforcement and documentation of vital information; coordination of post-discharge care; provision of rehabilitation support and promoting community reintegration; provision of counselling support; and using clear communication, patient empowerment and promoting self-efficacy. The identified consequences of the concept were as follows: improved patient outcomes; improved life quality; decreased healthcare cost; decreased re-admission rate and inpatient care burden; and decreased complication rate.

CONCLUSION

Healthcare self-management support for post-discharged stroke patients is an emerging concept that can help to significantly improve stroke patients' health outcomes and life quality. However, its applicability is uncertain considering the workload, time and resources available to healthcare professionals. There is a need for future studies to focus on the feasibility and applicability of this concept in clinical practice and to identify any challenges healthcare providers may have in supporting stroke patients after discharge.

IMPACT

This concept analysis brings clarity to the concept of healthcare self-management support of post-discharged stroke patients and distinguishes it from other self-management supports. It provides an opportunity for further studies and a pathway for generalized healthcare self-management support for stroke patients after discharge to improve health outcomes and quality of life.

NO PATIENT OR PUBLIC CONTRIBUTION

No patients, service users, caregivers or members of the public were involved in conducting this concept analysis.

Effects of a nurse-led peer support intervention on psychosocial outcomes of stroke survivors: A randomised controlled trial

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.

Feasibility of a self-management intervention to improve mobility in the community after stroke (SIMS): A mixed-methods pilot study

OBJECTIVE

To evaluate the feasibility of implementing a self-management intervention to improve mobility in the community for stroke survivors.

METHODS

A two-phase sequential mixed methods design was used (a pilot randomised controlled trial and focus groups). Participants were adult stroke survivors within six months post discharge from hospital with functional and cognitive capacity for self-management. The intervention included education sessions, goal setting and action planning, group sessions, self-monitoring and follow up. The control group received usual care and both groups enrolled for 3 months in the study. Feasibility outcomes (recruitment and retention rates, randomisation and blinding, adherence to the intervention, collection of outcome measures, and the fidelity and acceptability of the intervention). Participants assessed at baseline, 3 months and 6 months for functional mobility and walking, self-efficacy, goal attainment, cognitive ability, and general health. A descriptive analysis was done for quantitative data and content analysis for the qualitative data. Findings of quantitative and qualitative data were integrated to present the final results of the study.

RESULTS

Twenty-four participants were recruited and randomised into two groups (12 each). It was feasible to recruit from hospital and community and to deliver the intervention remotely. Randomisation and blinding were successful. Participants were retained (83%) at 3 months and (79.2%) at 6 months assessments. Adherence to the intervention varied due to multiple factors. Focus groups discussed participants' motivations for joining the programme, their perspectives on the intervention (fidelity and acceptability) and methodology, perceived improvements in mobility, facilitators and challenges for self-management, and suggestions for improvement.

CONCLUSION

The self-management intervention seems feasible for implementation for stroke survivors in the community. Participants appreciated the support provided and perceived improvement in their mobility. The study was not powered enough to draw a conclusion about the efficacy of the program and a future full-scale study is warranted.

A scoping review of factors associated with self-management in young adults with stroke

PURPOSE

To synthesize the available evidence on factors associated with self-management behavior in young stroke patients.

METHODS

The methodological guidelines for scoping reviews developed by the Joanna Briggs Institute and the PRISMA-scR-checklist for scoping reviews were used. A total of 5586 studies were identified through bibliographic searches of the scientific databases Medline (OVID), Embase (OVID), CINAHL (EBSCO), and PsycINFO, limited to the period 2000-2023. Studies were independently assessed for inclusion and exclusion criteria by two reviewers. Quantitative observational data and qualitative studies were extracted, mapped, and summarized to provide a descriptive summary of trends and considerations for future research.

RESULTS

Nine papers were finally selected to answer the research question. Young patients' self-management was mainly influenced by demographic factors (age, gender, income, education, and stroke knowledge), disease-related factors (functionality and independence, duration of stroke diagnosis, cognitive function, and poststroke fatigue), and psychosocial factors (hardiness, spiritual self-care, self-efficacy, and social support).

CONCLUSION

Further research is needed to determine the trajectory of poststroke self-management over time and its potential predictors, which should lead to the development of specific stroke rehabilitation and stroke self-management support programs for young people (considering factors that influence return to work in young stroke patients' self-management).

PRACTICE IMPLICATIONS

Healthcare providers can design more efficient interventions to improve the quality of life of young stroke patients after discharge. Gaining an in-depth understanding of the factors that influence self-management can help achieve this.

Self-Management among Stroke Survivors in the United States, 2016 to 2021

Background: Self-management among stroke survivors is effective in mitigating the risk of a recurrent stroke. This study aims to determine the prevalence of self-management and its associated factors among stroke survivors in the United States. Methods: We analyzed the Behavioral Risk Factor Surveillance System (BRFSS) data from 2016 to 2021, a nationally representative health survey. A new outcome variable, stroke self-management (SSM = low or SSM = high), was defined based on five AHA guideline-recommended self-management practices, including regular physical activity, maintaining body mass index, regular doctor checkups, smoking cessation, and limiting alcohol consumption. A low level of self-management was defined as adherence to three or fewer practices. Results: Among 95,645 American stroke survivors, 46.7% have low self-management. Stroke survivors aged less than 65 are less likely to self-manage (low SSM: 56.8% vs. 42.3%; p < 0.0001). Blacks are less likely to self-manage than non-Hispanic Whites (low SSM: 52.0% vs. 48.6%; p < 0.0001); however, when adjusted for demographic and clinical factors, the difference was dissipated. Higher education and income levels are associated with better self-management (OR: 2.49, [95%CI: 2.16-2.88] and OR: 1.45, [95%CI: 1.26-1.67], respectively). Further sub-analysis revealed that women are less likely to be physically active (OR: 0.88, [95%CI: 0.81-0.95]) but more likely to manage their alcohol consumption (OR: 1.57, [95%CI: 1.29-1.92]). Stroke survivors residing in the Stroke Belt did not self-manage as well as their counterparts (low-SSM: 53.1% vs. 48.0%; p < 0.001). Conclusions: The substantial diversity in self-management practices emphasizes the need for tailored interventions. Particularly, multi-modal interventions should be targeted toward specific populations, including younger stroke survivors with lower education and income.

An Umbrella Review of Self-Management Interventions for Health Conditions With Symptom Overlap With Traumatic Brain Injury

OBJECTIVE

To synthesize evidence for the effectiveness of self-management interventions for chronic health conditions that have symptom overlap with traumatic brain injury (TBI) in order to extract recommendations for self-management intervention in persons with TBI.

DESIGN

An umbrella review of existing systematic reviews and/or meta-analyses of randomized controlled trials or nonrandomized studies targeting self-management of chronic conditions and specific outcomes relevant to persons with TBI.

METHOD

A comprehensive literature search of 5 databases was conducted using PRISMA guidelines. Two independent reviewers conducted screening and data extraction using the Covidence web-based review platform. Quality assessment was conducted using criteria adapted from the Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2).

RESULTS

A total of 26 reviews met the inclusion criteria, covering a range of chronic conditions and a range of outcomes. Seven reviews were of moderate or high quality and focused on self-management in persons with stroke, chronic pain, and psychiatric disorders with psychotic features. Self-management interventions were found to have positive effects on quality of life, self-efficacy, hope, reduction of disability, pain, relapse and rehospitalization rates, psychiatric symptoms, and occupational and social functioning.

CONCLUSIONS

Findings are encouraging with regard to the effectiveness of self-management interventions in patients with symptoms similar to those of TBI. However, reviews did not address adaptation of self-management interventions for those with cognitive deficits or for populations with greater vulnerabilities, such as low education and older adults. Adaptations for TBI and its intersection with these special groups may be needed.

Comparisons between group- and individual-based interventions to support recovery from stroke and ischaemic heart disease in the community: a scoping review

PURPOSE

To map and summarise available literature on the effectiveness or other benefits of group- and individual-based interventions provided for adults living with stroke or ischaemic heart disease (IHD) in the community.

MATERIAL AND METHODS

The review was conducted based on JBI methodology and reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Articles were retrieved from: Medline, PsychInfo, Embase, Scopus, and CINAHL from 2002-2022. Extracted data from eligible studies included type of health outcomes (e.g., impairments), retention and adherence, social connectedness, and the costs associated with group- and individual-based interventions.

RESULTS

After screening, five articles (representing 4 unique studies) comparing a group- and individual-based intervention were included (total sample size n = 87). Three types of interventions were assessed: exercise (3/5), communication (1/5), and occupational therapy (1/5). Effectiveness of group- and individual-based interventions at improving health outcomes (i.e. physical ability, communication, motivation, and quality of life) is unclear. Currently there is insufficient evidence to guide clinical practice.

CONCLUSIONS

There is limited evidence comparing interventions delivered in a group and individual modality for adults living with stroke or IHD. Adequately powered studies are needed to determine if mode of delivery is equivalent or more cost effective.

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 rehabilitation adaptive approaches: A theory-focused scoping review

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.

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.

Developing and testing the feasibility of a new internet-based intervention-A case study of people with stroke and occupational therapists

INTRODUCTION

Internet-based interventions are called for within rehabilitation to meet the limited access to support for self-management after stroke. Therefore, a new intervention program, "Strategies for Empowering activities in Everyday life" (SEE) was developed. The aim of this study was to explore and describe how clients with stroke and their occupational therapists experienced the SEE intervention process and whether SEE has the potential to promote an active everyday life.

METHODS

A qualitative descriptive case study was designed. Four people with stroke (two of each sex, mean age 66,5 years) and their two occupational therapists (one of each sex) were included. A mix of data collection methods as interviews, assessments, registration forms and fieldnotes was used to uncover the participants' experiences and potential changes. Data were analysed with pattern matching.

FINDINGS

The analysed data formed three categories: "Not being able to take on the internet-based intervention", "Being facilitated in the change process of everyday life through the internet-based intervention", and "Providing a new internet-based intervention is a transition from ordinary practice". These categories included two to four subcategories that reflected aspects of SEE feasibility and acceptability with a focus on content and delivery.

CONCLUSION

The first test of the intervention indicates that the content and delivery of SEE can be feasible and acceptable both for clients and occupational therapists. The findings suggest that SEE has the potential to support clients' self-reflections and their adoption of strategies that influence engagement in daily activities and satisfaction with life in various ways. Further research with large-scale studies is needed.

Co-creation of self-management support during inpatient stroke rehabilitation

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.

Mobile Technology-Based Interventions for Stroke Self-Management Support: Scoping Review

BACKGROUND

There is growing interest in enhancing stroke self-management support using mobile health (mHealth) technology (eg, smartphones and apps). Despite this growing interest, "self-management support" is inconsistently defined and applied in the poststroke mHealth intervention literature, which limits efforts to synthesize and compare evidence. To address this gap in conceptual clarity, a scoping review was conducted.

OBJECTIVE

The objectives were to (1) identify and describe the types of poststroke mHealth interventions evaluated using a randomized controlled trial design, (2) determine whether (and how) such interventions align with well-accepted conceptualizations of self-management support (the theory by Lorig and Holman and the Practical Reviews in Self-Management Support [PRISMS] taxonomy by Pearce and colleagues), and (3) identify the mHealth functions that facilitate self-management.

METHODS

A scoping review was conducted according to the methodology by Arksey and O'Malley and Levac et al. In total, 7 databases were searched. Article screening and data extraction were performed by 2 reviewers. The data were analyzed using descriptive statistics and content analysis.

RESULTS

A total of 29 studies (26 interventions) were included. The interventions addressed 7 focal areas (physical exercise, risk factor management, linguistic exercise, activities of daily living training, medication adherence, stroke education, and weight management), 5 types of mobile devices (mobile phones or smartphones, tablets, wearable sensors, wireless monitoring devices, and laptops), and 7 mHealth functions (educating, communicating, goal setting, monitoring, providing feedback, reminding, and motivating). Collectively, the interventions aligned well with the concept of self-management support. However, on an individual basis (per intervention), the alignment was less strong.

CONCLUSIONS

On the basis of the results, it is recommended that future research on poststroke mHealth interventions be more theoretically driven, more multidisciplinary, and larger in scale.

Self-directed versus peer-supported digital self-management programmes for mental and sexual wellbeing after acquired brain injury (HOPE4ABI): protocol for a feasibility randomised controlled trial

BACKGROUND

Acquired brain injury (ABI) can lead to biopsychosocial changes such as depression, low self-esteem and fatigue. These changes can cause, and be caused by, sexual issues affecting relationships and wellbeing. Given the relationship between sexual wellbeing and mental health, it is feasible that supporting sexual wellbeing will benefit psychological wellbeing. However, neurorehabilitation is inconsistent and often fragmented across the UK, and psychological, sexual and social support are lacking. Research shows that self-management and peer-support programmes can improve quality of life, self-efficacy and psychological wellbeing after brain injury. This protocol describes a feasibility randomised controlled trial (RCT) of a digital self-management programme to support mental and sexual wellbeing (known as HOPE4ABI), co-designed with and for people with ABI.

METHODS

This mixed-methods feasibility RCT has two parallel trial arms of the 8-week digital HOPE4ABI self-management programme. Eligibility criteria include age > 18 years, diagnosed or suspected ABI > 3 months prior to trial entry, access to an Internet-enabled device and ability to engage with the intervention. Referrals to the study website will be made via the National Health Service (NHS), social media and partnering organisations. Sixty eligible participants will be randomised at a ratio of 1:1 to peer-supported (n = 30) or self-directed (n = 30) HOPE4ABI programmes. Primary feasibility outcomes include recruitment and retention rates, engagement, adherence and usage. Secondary outcomes related to standardised measures of quality of life, sexual wellbeing and mental wellbeing. Participants and peer facilitators will be interviewed after the course to assess acceptability across both trial arms.

DISCUSSION

This feasibility trial data is not sufficiently powered for inferential statistical analyses but will provide evidence of the feasibility of a full RCT. Quantitative trial data will be analysed descriptively, and participant screening data representing age, ethnicity and gender will be presented as proportions at the group level. These data may indicate trends in reach to particular demographic groups that can inform future recruitment strategies to widen participation. Progression to a definitive trial will be justified if predetermined criteria are met, relating to recruitment, retention, engagement and acceptability.

TRIAL REGISTRATION

ISRCTN46988394 registered on March 1, 2023.

"There are endless areas that they can use it for": speech-language pathologist perspectives of technology support for aphasia self-management

BACKGROUND

Aphasia is a debilitating acquired language disorder that often persists as a chronic condition. However, long-term support options are scarce, necessitating the consideration of alternative approaches. Chronic condition self-management approaches, which aim to build self-efficacy and empower people to take responsibility for the day-to-day management of their health condition, may benefit people with aphasia (PwA). Technology is widely used in chronic condition self-management and investigation is required to determine whether it could play a role in aphasia self-management.

OBJECTIVE

This study aimed to explore speech-language pathologist (SLP) perspectives on the potential use of technology to support aphasia self-management.

METHODS

A qualitative study was conducted with 15 SLPs using semi-structured interviews. Qualitative content analysis was applied to verbatim transcripts to identify codes, categories, and sub-themes which were developed into themes.

RESULTS

Three themes were identified: (1) technology supports holistic aphasia self-management by providing additional avenues for service delivery, overall communication, and learning opportunities thus enhancing independence and life participation; (2) SLP and communication partner (CP) assistance can support PwA to use technology for aphasia self-management; (3) considerations and potential barriers to PwA use of technology for aphasia self-management.

CONCLUSIONS

Technology can support aphasia self-management by expanding service delivery options, allowing for increased frequency and intensity of therapy practise, and facilitating communication and participation. Personal, professional, and organizational barriers should be addressed in the development of technology-enabled aphasia self-management approaches. SLPs and CPs can offer PwA assistance with technology but may themselves need additional support. Solutions for identified barriers should be considered, such as providing training in the use of technology and implementing aphasia-friendly modifications.IMPLICATIONS FOR REHABILITATIONSelf-management approaches are being explored in the area of aphasia management as a means of offering a holistic, sustainable intervention option that meets the long-term needs of people with aphasia.A range of technology-based resources are currently used in chronic condition self-management and in aphasia therapy, and there are many possibilities for the use of technology in aphasia self-management approaches.Speech-language pathologists identified that technology could facilitate aphasia self-management by expanding service delivery options (e.g., real-time and asynchronous telepractice), enabling increased frequency and intensity of therapy through providing a means of independent practise, offering options for augmentative alternative communication, and enhancing life participation by supporting social communication and daily tasks.,Speech-language pathologists are interested in using technology for aphasia self-management; however, barriers related to organizational policies, individual experience and confidence using technology, and technology itself must be addressed.

Lifetime and Acute Stress Predict Functional Outcomes Following Stroke: Findings From the Longitudinal STRONG Study

BACKGROUND

Stroke is a sudden-onset, uncontrollable event; stroke-related stress may impede rehabilitation and recovery. Lifetime stress may sensitize patients to experiencing greater stroke-related stress and indirectly affect outcomes. We examine lifetime stress as predictor of poststroke acute stress and examine lifetime and acute stress as predictors of 3- and 12-month functional status. We also compare acute stress and baseline National Institutes of Health Stroke Scale as predictors of poststroke functional status.

METHODS

Between 2016 and 2020 the STRONG Study (Stroke, Stress, Rehabilitation, and Genetics) enrolled adults with new radiologically confirmed stroke 2 to 10 days poststroke onset at 28 acute care US hospitals. Participants were interviewed 3 times: acute admission (acute stress; Acute Stress Disorder Interview), 3 months (Fugl-Meyer Upper Extremity motor impairment [Fugl-Meyer Upper Arm Assessment; N=431], modified Rankin Scale [3 months; N=542], Stroke Impact Scale-Activities of Daily Living [3 months; N=511], Lifetime Stress Exposure Inventory), and 12 months (modified Rankin Scale, N=533; Stroke Impact Scale 3.0 Activities of Daily Living; N=485; Telephone Montreal Cognitive Assessment; N=484) poststroke. Structural equation models examined whether acute stress predicted 3- and 12-month functional outcomes, and mediated an association between lifetime stress and outcomes controlling for demographics and initial National Institutes of Health Stroke Scale. Standardized betas are reported.

RESULTS

Sample (N=763) was 19 to 95 years old (mean=63; SD=14.9); 448 (58.7%) were male. Acute stress scores ranged from 0 to 14 (mean, 3.52 [95% CI, 3.31-3.73]). Controlling for age, gender, baseline National Institutes of Health Stroke Scale, and race and ethnicity, higher lifetime stress predicted higher acute stress (β=0.18, P<0.001), which predicted lower 3-month Fugl-Meyer Upper Arm Assessment scores (β=-0.19, P<0.001), lower Stroke Impact Scale 3.0 Activities of Daily Living scores at 3 months (β=-0.21, P<0.001) and 12 months (β=-0.21, P<0.001), higher modified Rankin Scale scores at 3 months (β=0.23, P<0.001) and 12 months (β=0.22, P<0.001), and lower 12-month Telephone Montreal Cognitive Assessment scores (β=-0.20, P<0.001). Acute stress predicted 12-month tMoCA (χ2[1]=5.29, P=0.022) more strongly, 3-month and 12-month modified Rankin Scale and SIS scores as strongly (all Ps>0.18), but Fugl-Meyer scores (χ2[1]=7.01, P=0.008) less strongly than baseline National Institutes of Health Stroke Scale.

CONCLUSIONS

Lifetime stress/trauma is associated with more poststroke acute stress, which is associated with greater motor and cognitive impairment and disability 3 and 12 months poststroke. Poststroke interventions for acute stress may help mitigate stroke-related disability.

The stroke transitional care intervention for older adults with stroke and multimorbidity: a multisite pragmatic randomized controlled trial

BACKGROUND

This study aimed to test, in real-world clinical practice, the effectiveness of a Transitional Care Stroke Intervention (TCSI) compared to usual care on health outcomes, self-management, patient experience, and health and social service use costs in older adults (≥ 55 years) with stroke and multimorbidity (≥ 2 chronic conditions).

METHODS

This pragmatic randomized controlled trial (RCT) included older adults discharged from hospital to community with stroke and multimorbidity using outpatient stroke rehabilitation services in two communities in Ontario, Canada. Participants were randomized 1:1 to usual care (control group) or usual care plus the 6-month TCSI (intervention group). The TCSI was delivered virtually by an interprofessional (IP) team, and included care coordination/system navigation support, phone/video visits, monthly IP team conferences, and an online resource to support system navigation. The primary outcome was risk of hospital readmission (all cause) after six-months. Secondary outcomes included physical and mental functioning, stroke self-management, patient experience, and health and social service use costs. The intention-to-treat principle was used to conduct the primary and secondary analyses.

RESULTS

Ninety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). No significant between-group differences were seen for baseline to six-month risk of hospital readmission. Differences favouring the intervention group were seen in the following secondary outcomes: physical functioning (SF-12 PCS mean difference: 5.10; 95% CI: 1.58-8.62, p = 0.005), stroke self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51-11.50, p = 0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p = 0.005). No between-group differences were found in total healthcare costs or other secondary outcomes.

CONCLUSIONS

Although participation in the TCSI did not impact hospital readmissions, there were improvements in physical functioning, stroke self-management and patient experience in older adults with stroke and multimorbidity without increasing total healthcare costs. Challenges associated with the COVID-19 pandemic, including the shift from in-person to virtual delivery, and re-deployment of interventionists could have influenced the results. A larger pragmatic RCT is needed to determine intervention effectiveness in diverse geographic settings and ethno-cultural populations and examine intervention scalability.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04278794 . Registered May 2, 2020.

Health Professional- and Volunteer-partnered Self-management Support (COMBO-KEY) to Promote Self-efficacy and Self-management Behaviors in People with Stroke: A Randomized Controlled Trial

BACKGROUND

Multiple systematic reviews have reported that self-management interventions are associated with positive impacts on self-efficacy and health-related quality of life (HRQoL) of people with stroke.

PURPOSE

This article reports the effects of an enhanced stroke self-management program.

METHODS

Eligible adults with stroke were recruited from community-based organizations and a support group for a two-arm, assessor-blinded randomized controlled trial. Participants in the control group received usual care, while those in the intervention group also received the 8-week self-management program, Coaching Ongoing Momentum Building On stroKe rEcovery journeY (COMBO-KEY), consisting of four individual home visits and five follow-up phone calls, delivered by healthcare professionals and trained volunteers. Assessments were conducted at baseline and after the intervention, for outcomes of self-efficacy, satisfaction with the performance of self-management behaviors, HRQoL, and community reintegration, which were analyzed using generalized estimating equations (GEEs).

RESULTS

134 Participants were recruited [mean age = 64.1 years, standard deviation (SD) = 12.7]. Over 80% of the participants had a first-ever stroke [mean years after first stroke: 4.2 (SD = 5.1)]. The GEE analysis revealed that the intervention group participants showed significantly greater improvements in self-efficacy, satisfaction with their performance of self-management behaviors, HRQoL, and community reintegration at 8-week follow-up with respect to their baseline levels.

CONCLUSIONS

The COMBO-KEY program showed effective improvements in recovery outcomes of people with stroke. Future research should explore the inclusion of virtual/hybrid sessions, strategies to assess health conditions of people with stroke via online modes, and assessment of goal attainment and actual performance of self-management behaviors.

Exploring the needs of stroke patients after discharge from rehabilitation centres in Saudi Arabian communities: An IPA qualitative exploratory study design

There are about 29 strokes per 100,000 people, annually, in the Kingdom of Saudi Arabia (KSA). These patients require long-term rehabilitation services to enhance recovery and independence in the community. Currently there are limited long-term rehabilitation services in KSA and research is needed to establish pathways for provision of community-based rehabilitation (CBR). To develop effective new CBR models, understanding the experiences and needs of stroke patients in KSA who have undergone poststroke care services is essential. This study aims to gain insight into stroke patients' needs after their discharge from rehabilitation centres in Saudi Arabia. An interpretive phenomenological analysis (IPA) study was undertaken using semi-structured interviews. Participants were eligible if they had a stroke, completed their in-hospital rehabilitation sessions and had been discharged within the past three years. Semi-structured interviews were conducted using interview guides. Transcripts were translated and analysed using interpretive phenomenological analysis. Twenty-four (15 males and 9 females) participants were recruited from two hospitals in KSA. The key findings suggested that patients experienced limited community rehabilitation services postdischarge unless they were financially able to pay for private therapy. Coping barriers including Medical, Psychological, Social, and Financial and facilitators including Faith, Recovery, Social support and leisure were identified. Participants suggested strategies to improve services within hospital and community for rehabilitation, needs of staff, access to services and ongoing care. Further work is required to develop, implement and evaluate a community rehabilitation intervention that includes education, and self-management elements to support stroke survivors in the community in KSA.

Stroke survivors' views on their priorities for upper-limb recovery and the availability of therapy services after stroke: a longitudinal, phenomenological study

PURPOSE

Forty percent of stroke survivors have a persistent lack of function in the upper limb, causing significant disability. Most personal-care tasks and meaningful activities require bi-manual function of both upper limbs. However, lower-limb mobility is often viewed as the priority in stroke services. Perspectives of stroke survivors on priorities for upper-limb recovery and therapy have not been investigated in detail. Therefore, this study aimed to explore their views.

MATERIALS AND METHODS

Thirteen stroke survivors each engaged in up to four semi-structured interviews over 18 months. A phenomenological approach guided the research.

RESULTS

Three themes were identified. Priorities change on coming home: recovery of walking is a priority early after stroke but upper-limb recovery becomes equally important over time, particularly once living at home. Limited therapy services: therapy has a short duration, prioritizes lower-limb mobility, and is short-lived in the community; people feel abandoned by services. Active partners in recovery: stroke survivors want intermittent access to review and advice so they can be active partners with therapists to manage their upper-limb recovery.

CONCLUSION

Therapy services should recognize stroke survivors' changing priorities and work with them as active partners in upper-limb recovery. Intermittent access to review and advice should be included in service design.Implications for rehabilitationStroke survivors' priorities may change over time from recovery of walking toward upper-limb recovery.Post-stroke services can be perceived as insufficient to meet the needs of stroke survivors who want to participate actively in rehabilitation of their upper limb.Stroke survivors may prefer services that are more flexible to provide regular review of their progress, access to guidance and support to self-manage their recovery.

Mobile health to promote physical activity in people post stroke or transient ischemic attack - study protocol for a feasibility randomised controlled trial

BACKGROUND

Physical activity is essential to improve health and reduce the risk of recurrence of stroke or transient ischemic attack (TIA). Still, people post stroke or TIA are often physically inactive and the availability of physical activity promotion services are often limited. This study builds on an existing Australian telehealth-delivered programme (i-REBOUND- Let's get moving) which provides support for home-based physical activity for people post stroke or TIA. The aim of this study is to test the feasibility, acceptability, and preliminary effects of a mobile Health (mHealth) version of the i-REBOUND programme for the promotion of physical activity in people post stroke or TIA living in Sweden.

METHODS

One hundred and twenty participants with stroke or TIA will be recruited via advertisement. A parallel-group feasibility randomised controlled trial design with a 1:1 allocation ratio to 1) i-REBOUND programme receiving physical exercise and support for sustained engagement in physical activity through behavioural change techniques, or 2) behavioural change techniques for physical activity. Both interventions will proceed for six months and be delivered digitally through a mobile app. The feasibility outcomes (i.e., reach, adherence, safety and fidelity) will be monitored throughout the study. Acceptability will be assessed using the Telehealth Usability Questionnaire and further explored through qualitative interviews with a subset of both study participants and the physiotherapists delivering the intervention. Clinical outcomes on preliminary effects of the intervention will include blood pressure, engagement in physical activity, self-perceived exercise self-efficacy, fatigue, depression, anxiety, stress and health-related quality of life and will be measured at baseline and at 3, 6 and 12 months after the baseline assessments.

DISCUSSION

We hypothesise that the mHealth delivery of the i-REBOUND programme will be feasible and acceptable in people post stroke/TIA living in rural and urban regions of Sweden. The results of this feasibility trial will inform the development of full-scale and appropriately powered trial to test the effects and costs of mHealth delivered physical activity for people after stroke or TIA.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05111951. Registered November 8, 2021.

Functional and Cognitive Occupational Therapy (FaCoT) Improves Self-Efficacy and Behavioral-Emotional Status of Individuals with Mild Stroke; Analysis of Secondary Outcomes

BACKGROUND

Mild stroke is characterized by subtle impairments, such as low self-efficacy and emotional and behavioral symptoms, which restrict daily living. Functional and Cognitive Occupational Therapy (FaC_oT) is a novel intervention, developed for individuals with mild stroke.

OBJECTIVES

To examine the effectiveness of FaC_oT compared to a control group to improve self-efficacy, behavior, and emotional status (secondary outcome measures).

MATERIAL AND METHODS

Community-dwelling individuals with mild stroke participated in a single-blind randomized controlled trial with assessments at pre, post, and 3-month follow-up. FaC_oT included 10 weekly individual sessions practicing cognitive and behavioral strategies. The control group received standard care. The New General Self-Efficacy Scale assessed self-efficacy; the Geriatric Depression Scale assessed depressive symptoms; the Dysexecutive Questionnaire assessed behavior and emotional status; and the 'perception of self' subscale from the Reintegration to Normal Living Index assessed participation.

RESULTS

Sixty-six participants were randomized to FaC_oT (n = 33, mean (SD) age 64.6 (8.2)) and to the control (n = 33, age 64.4 (10.8)). Self-efficacy, depression, behavior, and emotional status improved significantly over time in the FaC_oT group compared with the control, with small to large effect size values.

CONCLUSION

The efficacy of FaC_oT was established. FaC_oT should be considered for community-dwelling individuals with mild stroke.

Exploring the experiences of people who had a stroke and therapists who managed people with stroke during the COVID-19 pandemic: An exploratory qualitative study

OBJECTIVE

To explore experiences, needs and rehabilitation priorities of patients who had their stroke and the experiences of therapists managing stroke patients during the COVID-19 pandemic.

DESIGN

Exploratory qualitative study.

SETTING

Acute, sub-acute and community stroke facilities.

SUBJECTS

Twenty-two participants. Twelve therapists (all female, mean age 38.5 years) and ten patients (9 female, mean age 51.1 years) who were involved in stroke rehabilitation during the pandemic were interviewed.

METHODS

Individual semi-structured interviews were conducted. Interviews were recorded and transcribed before being analysed using a reflexive thematic analysis approach.

RESULTS

Four main themes demonstrate the modifications in the care system as a result of COVID-19, impact on the stroke patients at different stage, needs and priorities of stroke rehabilitation, and management strategies that have been used in stroke rehabilitation. Remote rehabilitation and self-management strategies were recommended to deliver care for stroke patients. However, therapists seemed unsatisfied with the quality of care delivered and patients suggested face to face delivery of care with proper personal protection equipment to better address their physical and mental health needs.

CONCLUSION

The findings of this study explored the impact of the pandemic on stroke care from the perspective of the patients and therapists and provides suggestions for improved delivery of care in similar situations. Future research is warranted to examine the long-term effects on people who had inadequate post-stroke rehabilitation during covid pandemic and urgent measures taken to reduce the impact the pandemic has had on the physical and mental issues for these patients.

Effectiveness of a Participatory Program for Improving the Cardiovascular and Cerebrovascular Health of Older Farmers in Rural Korea

BACKGROUND

The aim of this study was to evaluate the effectiveness of a participatory approach to the cardiovascular and cerebrovascular (CCV) health of older farmers in rural Korea.

METHODS

A nonequivalent control group pretest-posttest design was used. Participants included 58 farmers aged ≥ 60 years who were assigned to either an experimental group (n = 28) or a comparative group (n = 30). The experimental group took part in the participatory program for CCV health, while the comparative group received a conventional lecture program for CCV health. The two groups, from pretest to posttest, were compared using the generalized estimating equation (GEE) method.

RESULTS

The participatory program showed a greater effect over time than the conventional lecture program for health empowerment (Χ2 = 7.92, p = 0.005) and self-efficacy in managing CCV health (Χ2 = 5.94, p = 0.015). The average rate of implemented improvements after 3 months was 88.9%, showing that the participatory program was successful.

CONCLUSIONS

The participatory program for CCV health was an effective intervention for the empowerment and self-efficacy of older farmers in managing their own CCV health. Therefore, we recommend replacing lectures with participatory methods in CCV health programs for older farmers.

Some home-based self-managed rehabilitation interventions can improve arm activity after stroke: A systematic review and narrative synthesis

Background

There is an increased need for home-based, self-managed, and low maintenance stroke rehabilitation as well as interest in targeting the arm, which often lags behind leg recovery. Previous reviews have not controlled for concurrent standard of care and the ratio of self-managed care to therapist input.

Objectives

To determine the effectiveness of home-based, self-managed and low maintenance programs for upper-limb motor recovery in individuals after stroke. A secondary objective explored the adherence to home-based self-managed programs.

Data sources

We searched PubMed (1809-present), Embase (embase.com, 1974-present), Cochrane CENTRAL Register of Controlled Trials (Wiley), CINAHL (EBSCOhost, 1937-present), Physiotherapy Evidence Database (pedro.org.au), OTseeker (otseeker.com), and REHABDATA (National Rehabilitation Information Center). All searches were completed on June 9, 2022. Bibliographic references of included articles also were searched.

Eligibility criteria

Randomized controlled trials (RCT) in adults after stroke, where both intervention and control were home-based, at least 75% self-managed and did not involve concurrent therapy as a confounding factor. Primary outcome was performance in functional motor activities after training. Secondary outcome was sensorimotor impairment. All outcomes after a retention period were also considered secondary outcomes.

Data collection and analysis

Two review authors independently screened titles/abstracts, three review authors screened full papers and extracted data, and two review authors undertook assessment of risk of bias (i.e., allocation bias, measurement bias, confounding factors) using the NHLBI Study Quality Assessment Tool.

Main results

We identified seven heterogenous studies, including five with fair to good quality. All studies had an alternative treatment, dose-equivalent control. Only one trial reported a positive, sustained, between-group effect on activity for the experimental group. The remaining studies reported seven interventions having a within-group training effect with three interventions having sustained effects at follow up. One study reported a between group effect on an impairment measure with no follow-up. Overall adherence rates were high, but three studies reported differential group rates. Compliance with daily logs was higher when the logs were collected on a weekly basis.

Limitations

By excluding studies that allowed concurrent therapy, we likely minimized the number of studies that included participants in the early sub-acute post-stroke stage. By focusing on RCTs, we are unable to comment on other potentially promising home-based, self-managed single cohort programs. By including only published and English language studies, we may have included publication bias.

Conclusions and implications

There is some evidence that a variety of home-based, self-managed training program can be beneficial after stroke. Future research could compare such programs with natural history controls. Clinicians might utilize home exercise programs with explicit directions and some form of weekly contact to aid compliance.

The development of a self-management intervention for stroke survivors - My Life After Stroke (MLAS)

PURPOSE

Long-term needs of stroke survivors (especially psychosocial needs and stroke prevention) are not adequately addressed. Self-management programmes exist but the optimal content and delivery approach is unclear. We aim to describe the process undertook to develop a structured self-management programme to address these unmet needs.

MATERIALS AND METHODS

Based on the Medical Research Council framework for complex interventions, the development involved three phases: "Exploring the idea": Evidence synthesis and patient and public involvement (PPI) with stroke survivors, carers and healthcare professionals. "The iterative phase": Development and iterative refinement of the format, content, underpinning theories and philosophy of the self-management programme My Life After Stroke (MLAS), with PPI. MLAS consists of two individual appointments and four group sessions over nine weeks, delivered interactively by two trained facilitators. It aims to build independence, confidence and hope and focusses on stroke prevention, maximising physical potential, social support and managing emotional responses. MLAS is grounded in the narrative approach and social learning theory. "Ready for research": The refinement of a facilitator curriculum and participant resources to support programme delivery.

RESULTS

Through a systematic process, we developed an evidence- and theory-based self-management programme for stroke survivors.

CONCLUSIONS

MLAS warrants evaluation in a feasibility study.Implications for rehabilitationMy Life After Stroke(MLAS) has been developed using a systematic process, to address the unmet needs of stroke survivors.This systematic process, involved utilising evidence, theories, patient and public involvement, expertise and guidelines from other long-term conditions. This may further help the development of similar self-management programme within the field of stroke.MLAS warrants further evaluation within a feasibility study.

Self-management interventions to improve mobility after stroke: an integrative review

PURPOSE

To review the evidence around self-management interventions used to improve mobility post-stroke.

MATERIALS AND METHODS

An integrative review was carried out. Eight databases were searched from 1992 to July 2021 using keywords based on the PICOS strategy. Two reviewers independently screened and extracted the relevant data. Quality of studies was assessed and a quantitatively led narrative synthesis of data, supported by qualitative evidence, was then conducted.

RESULTS

Twenty-four studies with 823 participants were reviewed. Self-management strategies such as patient education, providing information, goal setting, problem-solving, action planning, self-monitoring, and social support were integrated with rehabilitation therapy to improve mobility post-stroke. The reviewed studies showed improvements in functional mobility and walking ability, self-efficacy, participation in physical activity, and quality of life to various extents. Participants in qualitative studies considered the self-management interventions as a valuable addition to their therapy and perceived the improvement in their mobility following them.

CONCLUSION

There is some evidence that self-management interventions help to improve mobility outcomes post-stroke. Heterogeneity of data in the studies made meta-analysis impossible. Most of the identified studies examined the feasibility and fidelity of the interventions and further research is warranted to examine the efficacy of these interventions to improve functional mobility post-stroke.Implications for rehabilitationSelf-management interventions can improve mobility-related outcomes, which are considered a priority goal for many stroke survivors.Survivors valued their participation in self-management integrated care programmes and linked that to the perceived improvement in their rehabilitation outcomes.Self-management interventions such as patient education, goal-setting, self-monitoring, and professionals/carers support have been found to improve mobility outcomes for stroke survivors.The outcomes that benefited to a slight extent using self-management were; functional mobility, walking ability (speed, distance, and endurance), and a number of steps per day.

The effectiveness of self-management interventions with action-taking components in improving health-related outcomes for adult stroke survivors: a systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aims to synthesise the evidence of the effectiveness of self-management interventions with action-taking components in improving self-efficacy, health-related quality of life, basic and instrumental activities of daily living, and depression for adult stroke survivors.

MATERIALS AND METHODS

Nine electronic databases were searched for relevant studies, including grey literature and ongoing studies. Randomised controlled trials targeting adult stroke survivors comparing health-related outcomes of patients receiving self-management interventions with action-taking components to usual care, placebo, or no-treatment were included. Screening, data extraction, and methodological quality assessment were conducted by two reviewers. Meta-analyses were performed. Overall quality of evidence was assessed using the GRADE tool.

RESULTS

A total of seventeen studies were included. Meta-analyses showed that the intervention may result in a slight increase in self-efficacy (SMD = 0.29, 95% CI [0.07-0.52], p = 0.010, I² = 47%) and basic activities of daily living (SMD = 0.31, 95% CI [0.16-0.46], p < 0.001, I² = 0%), but not for the other outcomes.

CONCLUSIONS

Self-management interventions with action-taking components may result in a slight improvement in self-efficacy and rehabilitation of basic activities of daily living. Future research should investigate which core self-management skill, or combination of them, is most effective in improving short-term and long-term outcomes.IMPLICATIONS FOR REHABILITATIONStroke can be a chronic condition as approximately half of stroke survivors suffer from permanent disabilities.Self-management interventions are one form of rehabilitation programmes available to stroke survivors.Self-management interventions with action-taking components may result in a slight increase in patient self-efficacy and carrying out basic activities of daily living compared to usual care given.

Contribution of participation and resilience to quality of life among persons living with stroke in Sweden: a qualitative study

PURPOSE

Resilience contributes to positive adaptation after many health conditions, but little is known about its contribution to long-term recovery after stroke. This study investigated the lived experience of resilience and participation and their relationship to quality of life after stroke in Sweden.

MATERIAL AND METHOD

Semi-structured telephone interviews were conducted with 19 informants (10 male, 9 female), aged from 44-89 years and between 1 and 19 years post-stroke. Stroke severity ranged from mild (n = 8), moderate (n = 9) to severe (n = 2). Interviews were analysed using content analysis.

RESULTS

The analysis resulted in an overarching theme; Life with stroke has been adapted to but not accepted, built on five subthemes: 1) Adapting and adjusting life, 2) Meaningful values in life, 3) Inner resources, 4) Support and treatment from social relations, and 5) Support and treatment from external resources.

CONCLUSION

Participants described a tension between adapting and accepting life after stroke. Resilience was a useful framework, highlighting the contribution of inner, social and societal resources to recovery and quality of life, both directly and as enhanced through increased participation. Important factors for adaptation are meaningful values in life, individual strategies for adaptation and support from both social relationship and the society.

Communication partner perspectives of aphasia self-management and the role of technology: an in-depth qualitative exploration

PURPOSE

"Self-management" empowers individuals to take responsibility for their healthcare through skill-building, personal growth, and self-efficacy related to chronic health condition management. Self-management approaches may benefit people with aphasia (PwA); however, PwA are often excluded from stroke self-management research and there is no published research reporting on aphasia-specific self-management programs. Communication partners (CPs) are involved in the rehabilitation and day-to-day lives of PwA, thus giving them unique insights and knowledge of PwA needs. The present study aimed to investigate CP experiences and perspectives regarding aphasia self-management and to explore CP perceptions of the use of technology in aphasia self-management.

METHODS

In-depth, semi-structured interviews with 14 CPs living in Australia. Interview data was analysed using qualitative content analysis.

RESULTS

Analysis revealed six core themes: (1) aphasia self-management is embedded into everyday life, (2) CPs provide comprehensive self-management support, (3) speech-language pathologists (SLPs) provide tools and support to enable PwA to self-manage, (4) aphasia self-management can be enhanced by technological supports, (5) potential positive outcomes of aphasia self-management, and (6) factors influencing successful aphasia self-management.

CONCLUSIONS

Aphasia self-management programs should focus on individual needs, functional communication in daily life, and social interaction. PwA and CPs are central to these programs, assisted by SLPs. Technology should be explored to augment aphasia self-management.Implications for RehabilitationCommunication partners suggest that people with aphasia are already engaging in aspects of self-management and that more formal aphasia-specific self-management approaches may be beneficial.Dedicated aphasia self-management programs should be situated in daily life with a focus on functional communication, life participation, confidence, and independence.Communication partners, speech-language pathologists, and technology are key support sources for aphasia self-management.Further input should be sought from communication partners in the development of aphasia self-management programs.

Mixed methods evaluation to explore participant experiences of a pilot randomized trial to facilitate self-management of people living with stroke: Inspiring virtual enabled resources following vascular events (iVERVE)

INTRODUCTION

Despite digital health tools being popular for supporting self-management of chronic diseases, little research has been undertaken on stroke. We developed and pilot tested, using a randomized controlled design, a multicomponent digital health programme, known as Inspiring Virtual Enabled Resources following Vascular Events (iVERVE), to improve self-management after stroke. The 4-week trial incorporated facilitated person-centred goal setting, with those in the intervention group receiving electronic messages aligned to their goals, versus limited administrative messages for the control group. In this paper, we describe the participant experience of the various components involved with the iVERVE trial.

METHODS

Mixed method design: satisfaction surveys (control and intervention) and a focus group interview (purposively selected intervention participants). Experiences relating to goal setting and overall trial satisfaction were obtained from intervention and control participants, with feedback on the electronic message component from intervention participants. Inductive thematic analysis was used for interview data and open-text responses, and closed questions were summarized descriptively. Triangulation of data allowed participants' perceptions to be explored in depth.

RESULTS

Overall, 27/54 trial participants completed the survey (13 intervention: 52%; 14 control: 48%); and 5/8 invited participants in the intervention group attended the focus group. Goal setting: The approach was considered comprehensive, with the involvement of health professionals in the process helpful in developing realistic, meaningful and person-centred goals. Electronic messages (intervention): Messages were perceived as easy to understand (92%), and the frequency of receipt was considered appropriate (11/13 survey; 4/5 focus group). The content of messages was considered motivational (62%) and assisted participants to achieve their goals (77%). Some participants described the benefits of receiving messages as a 'reminder' to act. Overall trial satisfaction: Messages were acceptable for educating about stroke (77%). Having options for short message services or email to receive messages was considered important. Feedback on the length of the intervention related to specific goals, and benefits of receiving the programme earlier after stroke was expressed.

CONCLUSION

The participant experience has indicated acceptance and utility of iVERVE. Feedback from this evaluation is invaluable to inform refinements to future Phase II and III trials, and wider research in the field.

PATIENT OR PUBLIC CONTRIBUTION

Two consumer representatives sourced from the Stroke Foundation (Australia) actively contributed to the design of the iVERVE programme. In this study, participant experiences directly contributed to the further development of the iVERVE intervention and future trial design.

The use of self-management strategies for stroke rehabilitation: a scoping review

INTRODUCTION

Self-management is generally considered a dynamic and collaborative process by individuals and caregivers to manage a chronic condition. Self-management has recently emerged as a promising strategy for stroke rehabilitation. This scoping review aims to examine and summarize self-management strategies utilized by stroke survivors for stroke rehabilitation.

METHODS

PubMed, Scopus, CINAHL (EBSCO), Embase, and ProQuest were searched for articles published between January 2010 and December 2021. Studies were selected if they were published in English in a peer-reviewed journal, utilized a non-experimental research design, and focused on adult stroke survivors. All relevant information from the included articles was extracted in a systematic way using a pre-developed data extraction form. Two authors performed data extraction and quality evaluation independently. All issues were resolved through discussion among the authors.

RESULTS

We narratively summarized the findings of 15 quantitative, qualitative, and mixed-method studies, including a total of 1,494 stroke survivors. The stroke survivors used a range of self-management strategies for their stroke rehabilitation, including domains related to lifestyle, social support, communication, knowledge and information, and goal-setting. Gender, age, stroke-related disability, fatigue, self-management education, social support, and communication with others were found to be associated with self-management use in stroke rehabilitation.

CONCLUSIONS

This scoping review provides an important overview on stroke survivors' use of self-management strategies and their experience. Their use of self-management strategies is complicated and multifaceted, comprising several domains and involving a diverse range of approaches and personal experiences. However, we identified several gaps in the literature and more research is required.

Using Mobile Video-Teleconferencing to Deliver Secondary Stroke Prevention Interventions: A Pilot Study

OBJECTIVES

Patient self-management support (SMS) interventions help stroke survivors control stroke risk factors and assist with secondary prevention. We examined utility and preliminary effectiveness of mobile video-teleconferencing (VT) to deliver SMS to stroke survivors in rural and low-income urban Texas communities.

METHODS

We applied a within-subjects design to assess improvement in self-management behaviors and stroke risk factors among stroke survivors receiving SMS intervention through mobile VT. Adults with stroke and two or more uncontrolled stroke risk factors were eligible. The SMS program, Video-teleconference-Self-management TO Prevent stroke (V-STOP) was delivered over 6 weeks by trained health coaches through VT. We applied Generalized Estimating Equations with site and time in intervention as covariates to evaluate psychological, social, physiological outcomes, self-management behaviors, and quality of life.

RESULTS

Mean age of 106 participants was 59.3 (±10.9); most were White, Hispanic men, living with someone, with low income. Approximately 69% completed all measures at 6 weeks. Median number of sessions attended was 5 (interquartile range 3) potentially avoiding 210 km of travel per person. Satisfaction with V-STOP and VT delivery was high, at (4.8 [±0.5]) and (4.7 [±0.5]), respectively. Stroke knowledge was improved from 8.8 (±1.0) at baseline to 9.6 (±0.7) at 12 weeks, (p < 0.0001). Improvements were observed in self-efficacy, exercise behaviors, depression and anxiety, disability, and quality of life.

CONCLUSION

Implementation of SMS is feasible and shows good utility and preliminary effectiveness of using mobile VT to provide stroke follow-up care to stroke survivors. Participants improved self-management behaviors and stroke risk factors.

Theory-Based Self-Management Interventions for Community-Dwelling Stroke Survivors: A Systematic Review and Meta-Analysis

IMPORTANCE

Self-management is a critical component of stroke rehabilitation. A better understanding of the use of theory and behavior change techniques (BCTs) informs the development of more effective stroke self-management interventions.

OBJECTIVE

To examine what theories and BCTs have been applied in stroke self-management interventions; investigate the extent to which these interventions encourage implementation of behavior changes; and appraise their effectiveness to enhance self-efficacy, quality of life, and functional independence.

DATA SOURCES

Ovid MEDLINE, Embase, Scopus, CINAHL, Cochrane Library, and ClinicalTrials.gov were searched from inception to May 26, 2020.

STUDY SELECTION AND DATA COLLECTION

Randomized controlled trials (RCTs) in six databases were reviewed for inclusion and analysis. We included trials that involved community-dwelling adult stroke survivors, assessed the effectiveness of self-management interventions, and explicitly mentioned the use of theory in the development of the intervention. We assessed use of theory and BCTs using the Theory Coding Scheme and BCT taxonomy v1, respectively.

FINDINGS

A total of 3,049 studies were screened, and 13 RCTs were included. The predominant theory and BCT categories were Social Cognitive Theory (7 studies) and goals and planning (12 studies), respectively. Significant and small effect sizes were found for self-efficacy (0.27) and functional independence (0.19).

CONCLUSIONS AND RELEVANCE

Theory-based self-management interventions have the potential to enhance stroke outcomes. Systematic reporting on the use of theory and BCTs is recommended to enhance clarity and facilitate evaluations of future interventions. What This Article Adds: This review supports and guides occupational therapy practitioners to use theory-based self-management intervention as a routine part of stroke rehabilitation to improve stroke survivors' experience in the community.

The effect of self-management programs on post-stroke social participation: A systematic review and meta-analysis

OBJECTIVE

The aim of this study was to identify the effectiveness of self-management programs on the improvement of social participation among stroke survivors. Data Sources: Cochrane Library, PubMed, Web of Science database, EMBASE, Medline, CINAHL plus, and APA PsycArticles were searched from their inception to December 20, 2021.

METHODS

We considered randomized controlled trials and non-randomized controlled trials without language limits. Two reviewers independently screened the literature, evaluated risk of bias using the Cochrane's risk of bias tool, scored the methodological quality using criteria of the Australian Evidence-based Health Care Center, and extracted the data. The outcome was social participation. RevMan 5.3 was used, and intergroup differences were determined by calculating standardized mean difference (SMD) and 95% confidence intervals (CIs).

RESULTS

Of 1894 initial studies, totally 15 studies met the eligible criteria, consisting of six randomized controlled trials and nine non-randomized controlled trials. Four randomized controlled trials showed high methodological quality and two demonstrated medium quality. The randomized controlled trials involved a total of 430 stroke survivors and were published between 2007 and 2020. The meta-analysis from five randomized controlled trials demonstrates that the overall effect of self-management programs on social participation was not statistically significant (95% CI, -0.23 to 0.40; p = 0.61). Most of the non-randomized controlled trials were pre-/post-test design with an average sample size of 15.4. The effect of self-management program on social participation in most non-randomized controlled trials was insignificant as well.

CONCLUSION

The self-management programs seem not to be superior to usual care for the improvement on social participation in stroke survivors based on current evidence. Further well-designed investigation considering social participation as the primary outcome is still warranted.

Evaluation of the evidence for self-management post-stroke within clinical practice guidelines for people with stroke: A systematic review

Introduction

Self-management post-stroke is essential where healthcare systems are stretched and stroke prevalence remains high. Self-management is recommended in stroke guidelines however, the quality of guidelines can vary and the evidence underpinning recommendations is unclear. The objectives of this paper are to identify and appraise current stroke guidelines, synthesise self-management recommendations and assess the evidentiary basis of these recommendations.

Method

Stroke guidelines were retrieved from a search of four databases and stroke association websites in July 2021. Four independent reviewers assessed their quality using the Appraisal of Guidelines Research and Evaluation 2nd Edition instrument. Self-management recommendations were extracted by hand, evaluated, synthesised and the evidence underpinning them appraised using the Canadian Stroke Best Practice Recommendations framework.

Results

Eleven guidelines were included in this systematic review, all of excellent methodological quality overall. One hundred and sixty-one recommendations were extracted from these guidelines and grouped into ten principles of self-management. A quarter of the recommendations were underpinned by level A evidence, 32% level B and 43% level C.

Conclusion

Although current stroke guidelines are of high methodological quality, there are considerable inconsistencies in self-management recommendations within and between these guidelines, with varying strengths of underpinning evidence. This article identifies a need for universal consensus regarding evidence-based self-management post-stroke.

A qualitative evaluation of participants experiences of living with back pain, lumbar fusion surgery, and post-operative rehabilitation

Background

The use of lumbar fusion surgery is increasing in developed economies. High levels of patient dissatisfaction are reported post-operatively. To address this need, we developed a theoretically informed rehabilitation programme for use following lumbar fusion surgery (the REFS programme). We conducted a mixed methods randomised controlled feasibility study (REFS v ‘usual care’). The numerical and feasibility outcomes are reported separately. The current qualitative study was ‘nested’ within the main feasibility study to explore participants’ experiences before and after lumbar fusion surgery including the impact of rehabilitation content. This facilitated a deeper understanding of potential mechanisms of action, for theoretical and programme refinement.

Methods

A purposive sample (n = 10 ‘usual care’, n = 10 REFS) was identified from the main feasibility study cohort. Individual semi-structured interviews were conducted post-operatively (median 8 months, range 5–11). Interview data were transcribed verbatim, coded, and analysed thematically.

Results

Three themes were constructed: the breadth and severity of impact associated with a chronic lumbar disorder was summarised in theme 1, ‘Ever-decreasing circles; living with a chronic lumbar disorder’. Theme 2, ‘What have I done? Reflections on recovery from lumbar fusion surgery’, illustrated participants post-operative helplessness, which was associated with worsening mental health, problematic use of opioids, fear related to the instillation of metalware, and the important mitigating effect of informal social support. Theme 3 ‘Rehabilitation experiences’ identified critical rehabilitation programme content including exercise, a shared rehabilitation experience, the opportunity for vicarious learning, and professional expertise.

Conclusions

To enhance patient benefit future REFS programme iterations should consider reinforcement of the identified valued programme content. Additional content should be considered to mitigate post-operative fear, which frequently aligned with the instillation of metalware into the spine. Participant’s perceptions regarding the necessity of lumbar fusion surgery has potential implications for the surgical consent process.

Trial registration

Study registration; ISRCTN60891364, date registered 10/7/2014.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-01050-y.

Effects of a Worksite-Based Self-Management Program in Traditional Retail Market Workers: Longitudinal Associations with Metabolic Parameters

(1) Background: This study explored the effects of a worksite-based self-management program on metabolic parameters in traditional retail market workers during a 3-year period. (2) Methods: Seventy traditional retail market workers who completed 3 years of follow-up were included in this study. The worksite-based self-management program was developed to help traditional retail market workers manage metabolic parameters themselves based on the following content: (I) using a metabolic syndrome action checklist, (II) counseling, (III) creating improvement action plans, and (IV) evaluating implemented improvements. (3) Results: The rates of implemented improvements showed success. Fasting blood sugar and triglycerides showed yearly reductions from baseline for 3 years, which eventually led to a decreased metabolic syndrome score and maintenance of metabolic parameters in the normal range for 3 years. (4) Conclusions: A worksite-based self-management program on metabolic parameters in traditional retail market workers was effective. It improved their intention to self-assess and cope their health problems and eventually decreased their metabolic syndrome score. It should be considered for the primary prevention of metabolic syndrome among traditional retail market workers.

Supported self-management in community stroke rehabilitation: what is it and how does it work? A protocol for a realist evaluation study

INTRODUCTION

A growing evidence base demonstrates the effectiveness of supported self-management in stroke for stroke survivors and their families. However, there is significant variation in its implementation in community stroke care and little understanding about how supported self-management works and is delivered across different settings, models used and contexts of community stroke rehabilitation.

METHODS AND ANALYSIS

Using a mixed method, realist approach across two phases, this protocol describes a study on community-based supported self-management. The aim is to identify the mechanisms and outcomes of supported self-management in stroke and to understand how supported self-management is implemented in different contexts of community stroke rehabilitation. Phase 1 involves (1) a realist synthesis, (2) a scoping and mapping of current community rehabilitation settings and (3) a Q-methodology study to develop initial programme theories about how community-based supported self-management works, for whom and in what contexts. Phase 2 involves realist informed interviews/focus groups with stroke survivors, community rehabilitation practitioners and team managers from across Scotland to test and refine programme theories and an explanatory model for how supported self-management works across different contexts of community-based stroke rehabilitation.

ETHICS AND DISSEMINATION

Ethical approval and R&D approvals have been granted from East of Scotland Research Ethics Committee (REC reference number: 19/ES/0055) and participating NHS boards. An understanding of how, for whom and in what contexts community-based supported self-management works will help to strengthen its delivery in practice. Such an understanding will enable the design of context-specific recommendations for policy and practice that genuinely reflect the challenges in implementing supported self-management in community stroke care. Results will be disseminated to clinical partners working in community stroke rehabilitation, stroke survivors and families and to policymakers and third sector partners involved in the provision of long-term support for people affected by stroke.

PROSPERO REGISTRATION NUMBER

CRD42020166208.

Strategies for Empowering activities in Everyday life (SEE 1.0): study protocol for a feasibility study of an Internet-based occupational therapy intervention for people with stroke

Background

Rehabilitation after stroke seldom focuses on needs related to an active everyday life and the process of change that people must undergo to adapt to an altered capacity and life situation. In particular, occupational therapy in the late phase needs to support clients in adopting sustainable self-initiated management strategies to regain daily activities and an active everyday life. To improve access to rehabilitation, the use of digital solutions has been suggested. This study aims to evaluate the feasibility of the Internet-based occupational therapy intervention “Strategies for Empowering activities in Everyday life” (SEE, version 1.0). We will investigate the feasibility of the intervention process in terms of acceptability and adherence as well as the most suitable outcome measures to evaluate SEE and improve the knowledge about the potential changes and outcomes of SEE for clients with stroke.

Methods

This feasibility study is based on a pretest posttest design without a control group. Quantitative and qualitative data will be collected from clients and staff concurrently embedded in a mixed-method design during the entire study.

Discussion

The project is a first test of a novel Internet-based occupational therapy intervention, and the research will contribute to the continued development and evaluation of the SEE programme. SEE can provide people with strategies in daily activities that can support them to live an active everyday life despite changed capacity and to improve access to rehabilitation interventions.

Trial registration

NCT04588116. Name of the registry: Strategies Empowering Activities in Everyday Life (SEE 1.0). A Web-based Occupational Therapy Intervention. URL of trial registry record. Date of registry: Trial first posted: October 19, 2020; first submitted: October 2, 2020

Use of participatory action research approach to develop a self-management resource for persons living with dementia

This article describes the use of a participatory action research (PAR) approach to developing a self-management resource for persons living with dementia and care partners. Despite growing evidence that persons with dementia are able to contribute in meaningful ways to decision-making about their care and life preferences, few opportunities exist for them to participate in the design of resources and services meant for them. There is also a need to support the self-management of persons living with dementia with the provision of accurate, high quality, user-friendly information. The Living Well with Dementia resource was developed through a partnership with persons with dementia, family members, Alzheimer Society representatives, primary care providers, and researchers. The methods used in the development of this resource are outlined in six steps employed in this process, from establishment of a PAR team to final resource creation. Informed by a whole systems approach, the resource brings together essential components of self-management into a comprehensive system of care and support for living. It empowers users to be active participants in the application of new knowledge to their lives. Better self-management has important implications for access to health care and quality of life for persons with dementia and care partners.

Impact of non-pharmacological interventions on activity limitations and participation restrictions in older breast cancer survivors: A scoping review

Cancer-related disability is a complex problem for older breast cancer survivors. One aspect of cancer-related disability is a survivor's inability to complete meaningful daily activities and engage in life roles, referred to as activity limitations and participation restrictions respectively. There is a limited understanding of how interventions influence activity limitations and participation restrictions in this population. A scoping review was undertaken to identify and characterize nonpharmacological interventions developed to address activity limitations and participation restrictions. A systematic search of electronic databases (Ovid Medline, Embase, EBSCO CINAHL, and Ovid PsycINFO) was conducted in April 2020 and updated October 2020. Eleven studies met inclusion criteria. Most frequently observed delivery features were in-person and one-on-one format. Six interventions incorporated telehealth delivery components. Interventions were often complex and varied in content. Exercise and behavioral strategies were among the most frequently used active ingredients. Activity limitations and participation restrictions were often secondary outcomes, and measures of these outcomes were varied in content and assessment method. Study samples were not representative of the current population of older adult breast cancer survivors. Future intervention research should clarify intervention delivery, content, and dose, prioritize comprehensive measurement of activity limitations and participation restrictions, as well as recruit and involve representative study samples to enhance generalizability of findings.

Self-management interventions for adults with stroke: A scoping review

BACKGROUND

Stroke is a principal cause of mortality and disability globally. Numerous studies have contributed to the knowledge base regarding self-management interventions among chronic disease patients, but there are few such studies for patients with stroke. Therefore, it is necessary to analyze self-management interventions among stroke patients. This scoping review aimed to systematically identify and describe randomized controlled trials (RCTs) of self-management interventions for adults with stroke.

METHODS

A review team carried out a scoping review on stroke and self-management interventions based on the methodology of Arksey and O'Malley, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, Embase, Web of Science, CINAHL Plus Full Text, Medline Plus Full Text, and Cochrane Central Register of Controlled Trials were searched from inception to July 2020.

RESULTS

Fifty-four RCTs were included. The most popular study design is comparing a self-management intervention to usual care or waitlist control condition. Physical activity is the most common intervention topic, and interventions were mainly delivered face to face. The majority of interventions were located in inpatient and multiple settings. Interventions were conducted by various providers, with nurses the most common provider group. Symptom management was the most frequently reported outcome domain that improved.

CONCLUSIONS

Self-management interventions benefit the symptom management of stroke patients a lot. The reasonable time for intervention is at least 6-12 months. Multifarious intervention topics, delivery formats, and providers are adopted mostly to meet the multiple needs of this population. Physical activity was the most popular topic currently. Studies comparing the effect of different types of self-management interventions are required in the future.

Effects of peer support interventions on physical and psychosocial outcomes among stroke survivors: A systematic review and meta-analysis

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.

Self-initiated management approaches in everyday occupations used by people with acquired cognitive impairment

BACKGROUND

Striving to cope with day-to-day challenges is a basic human behaviour. Self-initiated management approaches provide a resource that has yet to be discovered and systematically used in occupational therapy practice. This resource might be especially important for people with dementia who are less likely to adopt management approaches initiated by others.

AIMS/OBJECTIVES

Based on the findings of former studies on management and problem-solving actions among people with cognitive impairment, this article aims to identify and categorize the study participants' self-initiated management approaches and how these may be manifested in strategies in everyday occupations.

MATERIAL AND METHODS

The study utilized a form of meta-synthesis; an aggregated analysis, where findings from 11 studies published 2004-2020 were compared and categorized, incorporating the views of participants with dementia/mild cognitive impairment, or acquired brain injury.

RESULTS

Thirty strategies were identified and grouped into seven categories of management approaches, used in a variety of everyday occupations and situations. A majority of the strategies were found in both populations, suggesting that management approaches are more similar than different across populations with cognitive impairment.

CONCLUSIONS AND SIGNIFICANCE

Attending to the rich variation of self-initiated management approaches/strategies among persons with cognitive impairment offers possibilities for developing occupational therapy interventions.

Optimising the development of sustainable internet-based occupational therapy interventions: Important key actions and perspectives to consider

BACKGROUND

By examining the health needs of the general population and utilising the potential of digitalisation as a driving force, new internet-based services need to be developed in occupational therapy. However, existing guidelines for the development of complex interventions provide scant information on how to develop internet-based interventions.

AIM

The aim of this paper is to share experiences and illustrate important key actions and new perspectives to consider during the innovation process of developing and designing an internet-based occupational therapy intervention.

METHOD AND MATERIALS

International guidelines for intervention development was reviewed to add important perspectives in the innovation process.

RESULTS

The illustration focuses on five key actions in the development phase to highlight new perspectives and questions important to consider when designing new internet-based occupational therapy interventions.

CONCLUSION

The new perspectives can complement existing guidelines to enhance the development of more effective and sustainable internet-based interventions.

SIGNIFICANCE

The illustration provided has potential to improve the sustainability in innovation processes of new internet-based occupational therapy interventions.

Telehealth Interventions to Support Self-Management in Stroke Survivors: A Systematic Review

Telehealth (TH) intervention is a method to optimize self-management (SM) support in stroke survivors. Objectives of this study included identifying the TH-SM intervention's focus and SM support components, the TH delivery type, and the TH-SM support effects on stroke survivors. Five databases were searched for the years 2005-2020 to identify TH-SM support interventions for stroke survivors. Randomized controlled trials and quasi-experimental, one-group re-post study designs were included. Ten studies were reviewed. TH-SM support focused on post-stroke depression, obesity management, participation, functional mobility, and activities of daily living. The TH delivery type most used in selected studies was messaging. Regarding the SM support components, the education component was used in all studies, and psychological support and lifestyle advice and support were used in 8 out of 10 studies. TH-SM intervention had positive effects in terms of goal achievement for SM behavior, emotional state, and mobility of clinical outcomes, and TH acceptance in stroke survivors. Although the TH-SM-supported intervention effects were not found consistently in all outcomes, this review discovered a positive effect on various SM-related outcomes. In addition, TH delivery types and SM support components showed the possibility of various options to be considered for intervention. Therefore, we suggest that TH-SM supported intervention is a positive alternative for SM support in stroke survivors.

Strategies adopted to manage physical and psychosocial challenges after returning home among people with stroke: A qualitative study

Stroke survivors encounter various physical and psychosocial challenges after hospital discharge. Systematic reviews consistently suggest the importance of self-management in promoting post-stroke recovery. However, stroke survivors' performance of self-management behaviors after returning home is poorly understood. This study was conducted to explore how stroke survivors manage their life after returning home from the hospital. This was a qualitative study with individual, semi-structured interviews. We recruited a purposive sample of adults who had a first or recurrent ischemic or hemorrhagic stroke and currently lived at home. Participants were asked about their post-stroke experiences, challenges encountered, and strategies adopted for managing post-stroke conditions. Data were transcribed verbatim and analyzed using thematic analysis. A total of 30 stroke survivors (mean age = 61.97 years, SD = 10.20) were interviewed. Most were men (n = 18), married (n = 25), and retired (n = 21). Two-thirds had experienced an ischemic stroke. Five key themes emerged: pursuing lifelong learning to live well after a stroke; reinterpreting unpleasant experiences as new learning opportunities; engaging in life activities to better adapt to post-stroke challenges; being confident in oneself to persevere in self-management behaviors; and continuing to accept the current self and explore the new self. Participants regarded learning as a prerequisite for improving their affected functions and managing uncertainties in recovery. Learning requires self-participation, building self-efficacy and positive outcome expectations, testing and adapting strategies to one's own health conditions, and engaging in leisure or social activities. These findings will guide future development of interventions for enhancing stroke survivors' recovery outcomes.