Theory-based self-management programs for promoting recovery in community-dwelling stroke survivors : a systematic review

Lo, Suzanne H.S., Chang, Anne M., Chau, Janita P.C., & Gardner, Glenn E. (2013) Theory-based self-management programs for promoting recovery in community-dwelling stroke survivors : a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 11(12), pp. 157-215.

View at publisher



Post-stroke recovery is demanding. Increasing studies have examined the effectiveness of self-management programs for stroke survivors. However no systematic review has been conducted to summarize the effectiveness of theory-based stroke self-management programs.


The aim is to present the best available research evidence about effectiveness of theory-based self-management programs on community-dwelling stroke survivors’ recovery.

Inclusion criteria

Types of participants

All community-residing adults aged 18 years or above, and had a clinical diagnosis of stroke.

Types of interventions

Studies which examined effectiveness of a self-management program underpinned by a theoretical or conceptual framework for community-dwelling stroke survivors.

Types of studies

Randomized controlled trials.

Types of outcomes

Primary outcomes included health-related quality of life and self-management behaviors. Secondary outcomes included physical (activities of daily living), psychological (self-efficacy, depressive symptoms), and social outcomes (community reintegration, perceived social support).

Search Strategy

A three-step approach was adopted to identify all relevant published and unpublished studies in English or Chinese.

Methodological quality

The methodological quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for experimental studies.

Data Collection

A standardized JBI data extraction form was used. There was no disagreement between the two reviewers on the data extraction results.

Data Synthesis

There were incomplete details about the number of participants and the results in two studies, which makes it impossible to perform meta-analysis. A narrative summary of the effectiveness of stroke self-management programs is presented.


Three studies were included. The key issues of concern in methodological quality included insufficient information about random assignment, allocation concealment, reliability and validity of the measuring instruments, absence of intention-to-treat analysis, and small sample sizes. The three programs were designed based on the Stanford Chronic Disease Self-management program and were underpinned by the principles of self-efficacy. One study showed improvement in the intervention group in family and social roles three months after program completion, and work productivity at six months as measured by the Stroke Specific Quality of Life Scale (SSQOL). The intervention group also had an increased mean self-efficacy score in communicating with physicians six months after program completion. The mean changes from baseline in these variables were significantly different from the control group. No significant difference was found in time spent in aerobic exercise between the intervention and control groups at three and six months after program completion. Another study, using SSQOL, showed a significant interaction effect by treatment and time on family roles, fine motor tasks, self-care, and work productivity. However there was no significant interaction by treatment and time on self-efficacy. The third study showed improvement in quality of life, community participation, and depressive symptoms among the participants receiving the stroke self-management program, Stanford Chronic Disease Self-management program, or usual care six months after program completion. However, there was no significant difference between the groups.


There is inconclusive evidence about the effectiveness of theory-based stroke self-management programs on community-dwelling stroke survivors’ recovery. However the preliminary evidence suggests potential benefits in improving stroke survivors’ quality of life and self-efficacy.

Impact and interest:

0 citations in Scopus
Search Google Scholar™

Citation counts are sourced monthly from Scopus and Web of Science® citation databases.

These databases contain citations from different subsets of available publications and different time periods and thus the citation count from each is usually different. Some works are not in either database and no count is displayed. Scopus includes citations from articles published in 1996 onwards, and Web of Science® generally from 1980 onwards.

Citations counts from the Google Scholar™ indexing service can be viewed at the linked Google Scholar™ search.

ID Code: 66929
Item Type: Review
Refereed: Yes
Keywords: Disease management, Self-care, Self-efficacy, Stroke, Review, Systematic review
DOI: 10.11124/jbisrir-2013-1056
ISSN: 2202-4433
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Clinical Nursing - Tertiary (Rehabilitative) (111004)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Deposited On: 04 Feb 2014 21:58
Last Modified: 04 Feb 2014 22:00

Export: EndNote | Dublin Core | BibTeX

Repository Staff Only: item control page