Implementation of a stroke self-management program

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.