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Implementation of a stroke self-management program

A randomized controlled pilot study of veterans with stroke

  • Published:
Translational Behavioral Medicine

ABSTRACT

Secondary stroke prevention is championed as guideline care; yet there are no systematic programs offered. We developed a stroke self-management program to address this gap and pilot test the program. We conducted a randomized controlled trial at two Veterans Administration (VA) hospital sites where we recruited patients with an acute stroke to receive either the stroke program or an attention-control protocol over a 12-week period following hospital discharge. The stroke program included six sessions that facilitated stroke self management focusing on increasing self-efficacy to recover from stroke and engage in secondary stroke risk factor management. We surveyed outcomes at baseline, 3 and 6 months. We conducted an intention to treat analysis comparing the intervention to the control group on changes of outcomes between baseline and follow-up modeled by a linear model with fixed effects for treatment, visit, and the treatment by visit interaction adjusting for baseline. We recruited 63 participants (33 control and 30 intervention) who were hospitalized with a primary diagnosis of ischemic stroke. We found trends in differences between groups on self-efficacy to communicate with physicians, weekly minutes spent in aerobic exercise, and on dimensions of stroke-specific quality of life. This pilot study demonstrated the feasibility of delivering a stroke self-management program to recent stroke survivors in a healthcare organization. The program also demonstrated improvements in patient self-efficacy, self-management behaviors, specific dimensions of stroke-specific quality of life compared to a group that received an attention placebo program.

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Acknowledgements

This project was supported by a merit review grant from the VA Health Services Research and Development IMV#04-096. We thank Ms. Gloria Nicholas and Ms. Randi Cameron for providing case management to the study participants and Ms. Danielle Sager for providing research support. In addition, we thank the veterans and the clinical staff from the two VA facilities (Roudebush and Randall VAMCs) for their time and participation.

Author information

Authors and Affiliations

  1. HSRD COE, Regenstrief Institute, Inc., IU Center for Aging Research, VA Stroke QUERI Center and Indiana University School of Medicine, Indianapolis, IN, USA

    Teresa M Damush Ph.D. & Linda S Williams MD

  2. Biostatistics, Indiana University, Indianapolis, IN, USA

    Susan Ofner MS & Zhangsheng Yu Ph.D.

  3. VA Stroke QUERI Center, Roudebush VAMC, 1481 W 10th St, HSRD 11H, Indianapolis, IN, 46202, USA

    Teresa M Damush Ph.D., Laurie Plue MA, Gloria Nicholas BSN RN & Linda S Williams MD

  4. Neurology, VA Stroke QUERI Center and Indiana University, Indianapolis, IN, USA

    Teresa M Damush Ph.D. & Linda S Williams MD

Authors
  1. Teresa M Damush Ph.D.
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  2. Susan Ofner MS
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  3. Zhangsheng Yu Ph.D.
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  4. Laurie Plue MA
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  5. Gloria Nicholas BSN RN
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  6. Linda S Williams MD
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Corresponding author

Correspondence to Teresa M Damush Ph.D..

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Implications

Practice: To obtain optimal post stroke, specific quality of life, interventions fostering patient self management should occur at the level of recovery and secondary risk factor management for individuals.

Policy: Dedicating coordinated clinical resources to foster stroke self-management during recovery may increase patient access and participation.

Research: This report demonstrates the feasibility for delivering a stroke self-management program within a healthcare organization as well as the feasibility that patients with neurological deficits can access and participate.

APPENDIX 1: STROKE SELF-MANAGEMENT PROGRAM (SSMP) OVERVIEW

APPENDIX 1: STROKE SELF-MANAGEMENT PROGRAM (SSMP) OVERVIEW

The SSMP was delivered over six sessions delivered both in person (three sessions) and by telephone (three sessions) over a 3-month period. Additional telephone contacts focused on reinforcing, monitoring, and adjusting the goals and self-management strategies (biweekly calls) over the following 3 months. We have developed a detailed standardized program manual for all six sessions, which is available upon request. Below is the course overview as delivered over the six sessions.

Course Overview

Session

 

1

2

3

4

5

6

Overview of stroke/TIA and self-management

×

     

Changes caused by stroke

×

     

Warning signs of stroke

×

     

Expectations for recovery after stroke

×

     

Dealing with fears

×

     

Recognizing the Symptoms of Depression

×

 

×

 

×

 

Rehabilitation — keeping appointments and following prescribed exercise at home

×

×

×

×

×

×

Planning/Creating a Schedule

×

×

×

×

×

×

Feedback and problem-solving

 

×

×

×

×

×

Dealing with negative emotions

 

×

    

Getting Active at Home

 

×

 

×

  

Medication adherence

  

×

   

Adapting/Coping with Disabilities (stroke related)

 

×

×

×

×

×

Walking for health

  

×

×

×

 

Modifying your Diet (stroke risk factor management)

 

×

×

   

Relaxation — Deep breathing, Progressive Muscle Relaxation

 

×

×

×

×

×

Changing your outlook with positive thinking

  

×

   

Adapting to a new role after stroke — creating a schedule

  

×

   

Reducing Cholesterol, Hypertension (stroke risk factor management)

   

×

  

Finding a buddy (talking to stroke survivors)

  

×

   

Community resources — where to get help for stroke related issues and social needs

     

×

Working with health care providers and caregivers

    

×

 

Stop smoking

    

×

 

Reducing your alcohol

    

×

 

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Damush, T.M., Ofner, S., Yu, Z. et al. Implementation of a stroke self-management program. Behav. Med. Pract. Policy Res. 1, 561–572 (2011). https://doi.org/10.1007/s13142-011-0070-y

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  • DOI: https://doi.org/10.1007/s13142-011-0070-y

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