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.
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.
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).
A three-step approach was adopted to identify all relevant published and unpublished studies in English or Chinese.
The methodological quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for experimental studies.
A standardized JBI data extraction form was used. There was no disagreement between the two reviewers on the data extraction results.
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:
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|Keywords:||Disease management, Self-care, Self-efficacy, Stroke, Review, Systematic review|
|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|
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