Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4020 — Stroke Self-Management: Effectiveness on HRQOL

Lead/Presenter: Teresa Damush, COIN - Indianapolis
All Authors: Damush TM (PRISM QUERI; HSRD CHIC COIN Indianapolis) Mackey J (Indiana University School of Medicine) Saha C (Indiana University School of Medicine) Slaven J (Indiana University School of Medicine) Myers L (PRISM QUERI; HSRD CHIC COIN Indianapolis) Lincoln FL (PRISM QUERI; HSRD CHIC COIN Indianapolis) Nicholas G (Indiana University School of Medicine) Fleck JD (Indiana University School of Medicine) Ivan C (Indiana University School of Medicine) Williams LS (PRISM QUERI; HSRD CHIC COIN Indianapolis)

Objectives:
An acute stroke may serve as a major life event that may negatively effect functioning and well-being. We conducted a randomized, controlled trial to determine the effect of a stroke self-management program based upon social cognitive theory. The primary aim was to determine the effect of the patient-centered program on stroke, specific quality of life at 3 and 6 months.

Methods:
We enrolled 258 participants with an acute stroke (218) /TIA (40) from two VAMCs and a JC Stroke Center in the Midwest. Subjects were randomized to receive a 6 month self-management program or usual care and stratified by diagnosis and site. The program included 6 sessions with a case manager by telephone during the first 3 months and 3 monthly booster sessions as well as quarterly support group sessions. Participants completed a baseline, 3 and 6 month assessments including stroke specific, quality of life SSQoL, PHQ9, self-efficacy and demographics. The program was delivered with high fidelity: 16/19 program elements were delivered to > 90%. We conducted linear mixed effects models.

Results:
We enrolled our sample within 81.5 days after hospital discharge. Our sample included 19% women with an average age of 61.7 years. Our average NIHSS = 3 indicating mild stroke severity. The groups did not differ significantly at 3 months. However at 6 months, there was an intervention effect (m = 0.30 (0.07))on mean change in total SSQoL compared to usual care (m = 0.16 (0.07))adjusted for baseline value, site, dx, sex, and race (p < 0.05). There was also a significant interaction effect (p < 0.01) on the total SSQoL changes across the categories of the NIHSS stroke severity. We see the largest change in the minor stroke impairment group.

Implications:
A stroke self-management program is effective for stroke patients with some impairment. It appears that SSQoL improvements may need at least 6 months post a clinical event to achieve.

Impacts:
A patient-centered program may help to bridge recovery from an acute event from hospital discharge to the patient home and community reintegration. This program has the potential to be delivered adjuvant to traditional post stroke services.