Stroke Self-management: Effect On Self-efficacy, Exercise And Quality Of Life

Damush TM, Ofner S, Nicholas G, Plue LD, Yu Z, Williams LS. Stroke Self-management: Effect On Self-efficacy, Exercise And Quality Of Life. [Abstract]. Medicine and science in sports and exercise. 2010 May 1; 42(5):650.

PURPOSE: Secondary stroke prevention is championed as guideline care by the American Stroke Association. Moreover, from our preliminary work, stroke survivors are often left alone to cope with the psychosocial aftermath of recovery. We developed a stroke self-management program to address these gaps. The purpose of this study was to pilot test a stroke self-management program on self-efficacy, exercise, and quality of life. METHODS: We conducted a randomized controlled trial at two VA sites where we recruited patients with an acute stroke to receive either the stroke self-management program or an attention-control protocol over a 12-week period following hospital discharge. The standardized program was modeled after the Stanford Arthritis Self Management Program and tailored for post-stroke coping and recovery. Participants received 6 sessions targeting primary outcomes of stroke self management including post stroke depression, fears of injury, secondary stroke risk factor management, exercise and secondary outcomes of self-efficacy, and communication with providers using social learning theory as a framework. We surveyed outcomes at baseline and at 3 months. We conducted an intention to treat analysis comparing the intervention to the control group on outcomes using t-tests. RESULTS: We recruited 62 participants (33 control and 29 intervention) who were hospitalized with a primary diagnosis of ischemic stroke. The sample was 21.3% African-American and 69.8% White and all but 1 (1.6%) were men. We found trends in differences between groups on self-efficacy to exercise regularly (p < .07) and communicate with physicians (p < .04); minutes spent stretching (p < .09) and aerobic activity (p < .10) and on dimensions of stroke-specific quality of life (changes in family roles (p < .01), social roles (p < .05), work roles (p < .02) and thinking (p < .03)) and changes in social support (p < .05) and overall stroke quality of life (p < .07). CONCLUSIONS: This pilot study demonstrated the feasibility of delivering a stroke self-management program to recent stroke survivors. The program also demonstrated improvements in patient self-efficacy, self-management behaviors, social support and some dimensions of stroke-specific quality of life compared to a group that received an attention placebo program.