Bridges Self-Management Program for People with Stroke in the Community: A Feasibility Randomized Controlled Trial

Abstract

Background

Enabling self-management behaviors is considered important in order to develop coping strategies and confidence for managing life with a long-term condition. However, there is limited research into stroke-specific self-management interventions.

Aim

The aim of this randomized controlled trial was to evaluate the feasibility of delivering the Bridges stroke self-management program in addition to usual stroke rehabilitation compared with usual rehabilitation only.

Methods

Participants recruited from the referrals to a community stroke team were randomly allocated to the Bridges stroke self-management program, receiving either one session of up to one-hour per week over a six-week period in addition to usual stroke rehabilitation, or usual rehabilitation only. Feasibility was measured using a range of methods to determine recruitment and retention; adherence to the program; suitability and variability of outcome measures used; application and fidelity of the program; and acceptability of the program to patients, carers and professionals.

Results

Twenty-five people were recruited to the study over a 13-month period. Eight out of the 12 participants in the Bridges stroke self-management program received all six sessions; there was one withdrawal from the study. There were changes in outcomes between the two groups. Participants who received the Bridges stroke self-management program appeared to have a greater change in self-efficacy, functional activity, social integration and quality of life over the six-week intervention period and showed less decline in mood and quality of life at the three-month follow-up. Professionals found the program acceptable to use in practice, and feedback from participants was broadly positive.

Conclusions

The findings from this study appear promising, but questions remain regarding the feasibility of delivering the Bridges stroke self-management program in addition to usual rehabilitation. The dose response of receiving the program cannot be ruled out, and the next stage of research should explore the feasibility of an integrated program. Exploration of the reasons behind relatively low recruitment and of the sensitivity of outcome measures to detect a change are also required. Additional investigation of intervention fidelity is required to monitor if the program is being delivered as intended.

Keywords

behavioral intervention chronic disease clinical trial feasibility self-management stroke

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References

WHO. Global Status Health Report on Noncommunicable Diseases 2010. Geneva, World Health Organization, 2010.

Care Quality Commission. Supporting Life after Stroke: A Review of Services for People Who Have Had a Stroke and Their Carers. London, Care Quality Commission, 2011.

McKevitt

Fudge

Redfern

. Self-reported long-term needs after stroke. Stroke 2011; 42: 1398–403.

Jones

. Strategies to enhance chronic disease self-management: How can we apply this to stroke? Disabil Rehabil 2006; 28: 841–7.

Barlow

Sturt

Hearnshaw

. Self-management interventions for people with chronic conditions in primary care: Examples from arthritis, asthma and diabetes. Health Educ J 2002; 61: 365–78.

de Silva

. Helping People Help Themselves: A Review of the Evidence Considering Whether it is Worthwhile to Support Self-Management. London, The Health Foundation, 2011.

Lennon

McKenna

Jones

. Self-management programmes for people post stroke: A systematic review. Clin Rehabil 2013; 27: 867–78.

Cadilhac

Hoffmann

Kilkenny

. A phase II multicentered, single-blind, randomized, controlled trial of the stroke self-management program. Stroke 2011; 42: 1673–9.

Kendall

Catalano

Kuipers

Posner

Buys

Charker

. Recovery following stroke: The role of self-management education. Soc Sci Med 2007; 64: 735–46.

10.

Jones

Mandy

Partridge

. Changing self-efficacy in individuals following first stroke: Preliminary study of a novel self-management intervention. Clin Rehabil 2009; 23: 522–33.

11.

The EuroQol Group. EuroQol – a new facility for the measurement of health-related quality of life. Health Policy 1990; 16: 199–208.

12.

Williams

Weinberger

Harris

Clark

Biller

. Development of a stroke-specific quality of life scale. Stroke 1999; 30: 1362–9.

13.

Lorig

Stewart

Ritter

Gonzalez

Laurent

Lynch

. Outcome Measures for Health Education and Other Health Care Interventions. California, Sage Publications, 1996.

14.

Jones

Partridge

Reid

. The Stroke Self-Efficacy Questionnaire: Measuring individual confidence in functional performance after stroke. J Nurs Healthcare Chronic Dis 2008; 17(7b): 244–52.

15.

Mahoney

Barthel

. Functional evaluation: The Barthel Index. Md State Med J 1965; 14: 61–3.

16.

Nouri

Lincoln

. An extended activities of daily living scale for stroke patients. Clin Rehabil 1987; 1: 301–5.

17.

Goldberg

Hillier

. A scaled version of the General Health Questionnaire. Psychol Med 1979; 9: 139–45.

18.

Trigg

Wood

. The Subjective Index of Physical and Social Outcome (SIPSO): A new measure for use with stroke patients. Clin Rehabil 2000; 14: 288–99.

19.

Hodkinson

. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 1972; 1: 233–8.

20.

Bhavnani

Cockburn

Lincoln

. The reliability of the Rivermead Assessment and implications for some commonly used assessments of perception. Br J Occup Ther 1983; 46: 17–9.

21.

Jones

. Factors which influence the resumption of activity and participation following stroke. PhD thesis, University of Brighton, Brighton, UK, 2005.

22.

Bandura

. The nature and structure of self-efficacy. In: Bandura

(ed): Self-Efficacy: The Exercise of Control. New York, W.H Freeman and Company, 1997.

23.

Lorig

Holman

. Self-management education: History, definition, outcomes and mechanisms. Ann Behav Med 2003; 26: 1–7.

24.

Marks

. Efficacy theory and its utility in arthritis rehabilitation: Review and recommendations. Disabil Rehabil 2001; 23: 271–80.

25.

Nachar

. The Mann–Whitney U: A test for assessing whether two independent samples come from the same distribution. Tutorials Quant Meth Psych 2008; 4: 13–20.

26.

Jones

Riazi

Norris

. Self-management after stroke: Time for some more questions. Disabil Rehabil 2012; 35: 257–64.

27.

Kennedy

Rogers

Bower

. Support for self care for patients with chronic disease. BMJ 2007; 335: 968–70.

28.

Jones

Lennon

. A new stroke self-management programme: Preliminary analysis of training for practitioners. Int J Stroke 2009; 4(s2): 23.