Self-Efficacy to Manage Health After Stroke is Related to Quality of Life

Damush TM, Mackey J, Thomas K, Saha C, Slaven J, Lincoln F, Fleck JD, Myers L, Ivan C, Williams LS. Self-Efficacy to Manage Health After Stroke is Related to Quality of Life. [Abstract]. Circulation. 2017 Mar 7; 135(Suppl 1):AP331.

Objective: An acute stroke may serve as a major life event that disrupts health-related quality of life. We examined psychosocial and demographic factors related to functioning and well-being after stroke among patients discharged from two health care systems: Veterans Health Administration (VHA) and a Joint Commission Stroke Center. Methods: We enrolled 258 participants into a randomized controlled trial to evaluate a stroke self-management program which targeted functional recovery and risk factor management. All participants completed written consent and a baseline assessment which included demographics, depressive symptoms, self-efficacy, stroke specific, health-related quality of life (SSQoL) and psychosocial factors. We conducted multivariate analyses to evaluate factors related to baseline SSQoL using a social cognitive framework. Results: We enrolled our sample, on average, within 81.5 days after hospital discharge for stroke/TIA. Our sample included 19% women with an average age of 61.7 (10.8) years. The average NIH stroke scale score was 3.0 indicating minor stroke. Across the total and subdomains of SSQoL, self-efficacy to manage stroke health and symptoms was associated with overall better SSQoL (0.16, p < 0.0001), social role functioning (0.12, p < 0.01), family role functioning (0.16, p < 0.0003), and work role functioning (0.31, p < 0.0001). Depressive symptoms were significantly related to poorer SSQoL across all subdomains; however distance walked in a mobility test was not significantly related. Optimism was related to total SSQoL (p < .07) and perceived energy (p < 0.02). Demographics were not significantly related to SSQoL in the multivariate models. Conclusions: As social cognitive theory suggests, self-efficacy to manage symptoms and health after stroke and a sense of optimism for recovery are significantly related to greater stroke specific, health-related quality of life shortly after hospital discharge for stroke. Post stroke programs which target building self-efficacy and providing optimism for recovery may enhance SSQoL. Our stroke self-management program targets these concepts and we are currently evaluating our prospective outcomes.