Given the lack of patient-centered, self-care programs after stroke, we designed a stroke self-management program based upon social cognitive theory and stakeholder input.
Objectives: We conducted a randomized controlled trial to evaluate the effectiveness of the program after stroke on stroke specific, quality of life, SSQOL, and maintenance at 1 year.
Methods: We enrolled 258 participants within 90 days of a stroke, on average, stratified by stroke, n=218, or TIA, n=40, and by VA and nonVA healthcare systems. The program included telephone case management, support groups, and booster calls. Outcomes of SSQoL, PHQ9, self-efficacy were assessed at 0, 3, 6, and 12 months. We compared the intervention to usual care using linear mixed effects modeling.
Results: We delivered the program with high fidelity: 16/19 elements were delivered to > 90%. Our sample included 19% women with an average age of 61.7 years with an average NIHSS=3. At 3 months, the groups did not differ. However, at 6 months, we report an adjusted intervention effect on mean change in total SSQoL, m=0.30, compared to usual care m=0.16, p< 0.05. We found a significant interaction effect, p<0.01, on the total SSQoL changes across the categories of the NIHSS stroke severity. We saw the largest change in the minor stroke impairment group. Moreover, we found significant intervention effects on the self-efficacy to manage stroke health p<0.04 and physical functioning domain, p<0.03. At 12 months, the group differences were no longer significant.
Conclusions: A stroke self-management program is effective for improving the health-related quality of life, self-efficacy to manage health and physical functioning of patients after an acute stroke during the first six months post discharge. Long term maintenance may need additional support and resources. Finally, our results remained significant after adjusting for the healthcare system, patient demographics and whether the acute event was a stroke or TIA. Thus, healthcare systems may consider implementing such programs as patients transition after the acute health event.