Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial

Janet W.H. Sit, Sek Ying Chair, Kai Chow Choi, Carmen W.H. Chan, Diana T.F. Lee, Aileen W.K. Chan, Jo L.K. Cheung, Siu Wai Tang, Po Shan Chan, Ruth E Taylor-Piliae

Research output: Contribution to journalArticle

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Abstract

Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients’ ability to participate in self-management. Purpose: To examine the effects of the empowerment intervention on stroke patients’ self-efficacy, self-management behavior, and functional recovery. Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results: A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.

Original languageEnglish (US)
Pages (from-to)1441-1450
Number of pages10
JournalClinical Interventions in Aging
Volume11
DOIs
StatePublished - Oct 13 2016

Fingerprint

Self Care
Randomized Controlled Trials
Stroke
Self Efficacy
Patient Participation
Survivors
Health
Control Groups
Neurobehavioral Manifestations
Ambulatory Blood Pressure Monitoring
Aptitude
Medication Adherence
Touch
Hong Kong
Paresis
Ambulatory Care
Rehabilitation
Communication
Power (Psychology)
Physicians

Keywords

  • Activities of daily living
  • Functional recovery
  • Patient empowerment
  • Rehabilitation
  • Self-management
  • Stroke

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial. / Sit, Janet W.H.; Chair, Sek Ying; Choi, Kai Chow; Chan, Carmen W.H.; Lee, Diana T.F.; Chan, Aileen W.K.; Cheung, Jo L.K.; Tang, Siu Wai; Chan, Po Shan; Taylor-Piliae, Ruth E.

In: Clinical Interventions in Aging, Vol. 11, 13.10.2016, p. 1441-1450.

Research output: Contribution to journalArticle

Sit, Janet W.H. ; Chair, Sek Ying ; Choi, Kai Chow ; Chan, Carmen W.H. ; Lee, Diana T.F. ; Chan, Aileen W.K. ; Cheung, Jo L.K. ; Tang, Siu Wai ; Chan, Po Shan ; Taylor-Piliae, Ruth E. / Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial. In: Clinical Interventions in Aging. 2016 ; Vol. 11. pp. 1441-1450.
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title = "Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial",
abstract = "Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients’ ability to participate in self-management. Purpose: To examine the effects of the empowerment intervention on stroke patients’ self-efficacy, self-management behavior, and functional recovery. Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results: A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49{\%} women, 72{\%} ischemic stroke, 89{\%} hemiparesis, and 63{\%} tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7{\%}. Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.",
keywords = "Activities of daily living, Functional recovery, Patient empowerment, Rehabilitation, Self-management, Stroke",
author = "Sit, {Janet W.H.} and Chair, {Sek Ying} and Choi, {Kai Chow} and Chan, {Carmen W.H.} and Lee, {Diana T.F.} and Chan, {Aileen W.K.} and Cheung, {Jo L.K.} and Tang, {Siu Wai} and Chan, {Po Shan} and Taylor-Piliae, {Ruth E}",
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T1 - Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial

AU - Sit, Janet W.H.

AU - Chair, Sek Ying

AU - Choi, Kai Chow

AU - Chan, Carmen W.H.

AU - Lee, Diana T.F.

AU - Chan, Aileen W.K.

AU - Cheung, Jo L.K.

AU - Tang, Siu Wai

AU - Chan, Po Shan

AU - Taylor-Piliae, Ruth E

PY - 2016/10/13

Y1 - 2016/10/13

N2 - Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients’ ability to participate in self-management. Purpose: To examine the effects of the empowerment intervention on stroke patients’ self-efficacy, self-management behavior, and functional recovery. Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results: A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.

AB - Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients’ ability to participate in self-management. Purpose: To examine the effects of the empowerment intervention on stroke patients’ self-efficacy, self-management behavior, and functional recovery. Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results: A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.

KW - Activities of daily living

KW - Functional recovery

KW - Patient empowerment

KW - Rehabilitation

KW - Self-management

KW - Stroke

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