Effects of a Goal-Oriented Intervention on Self-Management Behaviors and Self-Perceived Burden After Acute Stroke: A Randomized Controlled Trial

 Since everyone's goal is 100% recovery, EXACTLY HOW IS THIS GOING TO GET THEM THERE?

Effects of a Goal-Oriented Intervention on Self-Management Behaviors and Self-Perceived Burden After Acute Stroke: A Randomized Controlled Trial

Yu Chen^1†, Yuanyuan Wei^2†, Hongjuan Lang¹, Ting Xiao¹, Yan Hua¹, Lu Li³, Jing Wang¹, Hongxia Guo^4*‡ and Chunping Ni^1*‡

• ¹School of Nursing, Fourth Military Medical University, Xi'an, China
• ²Leshan Retired Cadre Sanatorium, Leshan, China
• ³College of Basic Medicne, Fourth Military Medical University, Xi'an, China
• ⁴West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China

Background: Stroke generates significant health and social burdens. Self-management has potential importance for supporting individuals in coping and continuing to progress after stroke. However, there is a lack of targeted programs to enhance self-management and reduce self-perceived burden (SPB) following stroke.

Purpose: To evaluate the effects of a goal-oriented intervention on self-management behaviors and SPB among patients after acute stroke.

Methods: This was a randomized controlled trial with a 4-weeks intervention. Participants were randomly allocated to the intervention (n = 48) or control group (n = 48). The intervention and control groups received eight sessions of goal-oriented self-management intervention based on Pender's health promotion model and control care, respectively. Self-management behaviors and SPB were evaluated and compared between the two groups.

Results: After the 1-month follow-up, there were significant differences in the total self-management behaviors score and the scores of six of the self-management dimensions, excluding diet management, between the intervention group and the control group (t = −7.891– −2.815; p ≤ 0.006). Compared to the control group, the intervention group showed a significant decrease in the physical burden, emotional burden, and total SPB scores (t = 2.102–2.071; p = 0.015–0.041). The economic burden score was not significantly different between the two groups (t = 1.707; p = 0.091).

Conclusion: The goal-oriented intervention based on Pender's health promotion model can effectively improve self-management behaviors and reduce physical and emotional SPB among stroke survivors.

Introduction

Globally, stroke was the third leading cause of disability-adjusted life-years (DALYs) and the second leading cause of death worldwide in 2017 (1, 2). In the United States, someone has a stroke approximately every 40 s, and someone dies of stroke every 4 min, and 50–70% of stroke survivors suffer from chronic neurological or cognitive impairment (3). The overall burden of stroke, including health, economic, and social costs, has been increasing for individuals, families, and national healthcare systems (1, 4). Stroke-related healthcare costs were estimated at $73.3 billion in 2010 (3). For stroke survivors, especially those with disabilities, receiving care imposes a high level of self-perceived burden (SPB). SPB is defined as “empathic concern engendered from the impact on others of one's illness and care needs, resulting in guilt, distress, feelings of responsibility, and diminished sense of self” (5). The study of Ren et al. showed that 65.8% of inpatients with stroke had SPB (6). SPB has negative influences on patients' rehabilitation and quality of life (7, 8). The mortality of recurrent stroke is higher than that of first-ever stroke (9–11). The negative impact of SPB will further increase the risk of stroke recurrence. Hence, stroke survivors' reduction in SPB should be considered equally important as other measures in their rehabilitation and the prevention of stroke recurrence.

Self-management has been advocated as one of the key strategies that enables individuals to reduce the risk of subsequent stroke, practice new healthy behaviors, and improve quality of life following stroke (12–14). At the national and international levels, self-management education programs have been recognized as an important approach to addressing the burden of chronic disease and helping individuals manage their condition more effectively (15, 16). However, evidence from six studies showed that self-management programs were not superior to other programs in terms of their effects in the domains of locus of control, activities of daily living, medication adherence, participation, or mood (17). In China, many stroke patients lack disease and rehabilitation management behaviors. There is little knowledge about the prevention of stroke recurrence, reduction in complications, and rehabilitation exercise (18). Individuals' capacity and support for self-management affect their stroke self-management (19). Currently, targeted programs to enhance self-management behaviors and reduce SPB following acute stroke are lacking.

Successful interventions for patients with chronic diseases should pay attention to health-promoting lifestyles and their influencing factors (20). Pender's health promotion model emphasizes assisting people in changing their lifestyles and moving toward a state of optimal health (21). Goal-oriented instructions were proven to be effective in increasing the intensity of practice in stroke rehabilitation (22). While previous studies have assessed health behavior modification after stroke, no randomized controlled trials have been developed to test the effectiveness and feasibility of an intervention combined with a self-management goal and Pender's model. Thus, the current study designed a goal-oriented self-management intervention based on Pender's health promotion model for stroke patients. Telephone follow-up intervention has been found to be effective in improving health behaviors among many chronic disease patients, such as hypertensive patients for cardiovascular disease risk reduction (23) and diabetes patients for self-care activities (24). In this study, the telephone follow-up intervention was delivered early after acute stroke. The main aim was to test whether the program could improve self-management behaviors and reduce the SPB of stroke patients in the first month after discharge.

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Predictors and Changes of Self-Perceived Burden Among Stroke Survivors: A 3-Month Follow-Up Study

This is all a direct result of not having protocols leading to 100% recovery. Solve the primary problem, 100% recovery, NOT this distress/anxiety from your medical team not knowing what the fuck to do to get you 100% recovered. 

Predictors and Changes of Self-Perceived Burden Among Stroke Survivors: A 3-Month Follow-Up Study

Yuanyuan Wei^1,2†, Xiaoran Ren^3†, Xiangni Su¹, Xianni Wang⁴, Yan Hua¹, Yu Chen¹, Ruijie Shi¹, Pei Shao¹, Hongjuan Lang¹ and Chunping Ni^1*

• ¹School of Nursing, The Fourth Military Medical University, Xi'an, China
• ²Leshan Retired Cadre Sanatorium, Sichuan Military Region, Leshan, China
• ³Department of Nursing, Shaanxi Traditional Chinese Medicine Hospital, Xi'an, China
• ⁴Tangdu Hospital, The Fourth Military Medical University, Xi'an, China

Background and Purpose: Patients' self-perceived burden (SPB) is associated with distress, which has a potentially negative influence on disease rehabilitation and quality of life. Stroke represents a significant health and social burden. The aim of the study was to assess, compare, and identify predictors of SPB in stroke survivors during the first 3 months post-stroke.

Methods: A prospective longitudinal study was used. Consecutive stroke inpatients were recruited from the neurology department of three general hospitals in Xi'an, China. Patients were surveyed using the Self-perceived Burden Scale (SPBS) on the fourth day of admission (Acute phase, Time 1, T1) and 1 month (Time 2, T2) and 3 months (Time 3, T3) post-stroke.

Results: Considerable burden was experienced by 84.15–91.50% of patients in the first 3 months post-stroke. The mean score of physical burden was the highest. Over time, physical, emotional, and economic burden all declined. The following characteristics had significant association with increased patient SPB at T1, T2, and T3: age, self-evaluated economic pressure, comorbidity, and functional status (P < 0.01). Patients' knowledge about stroke was only significantly associated with SPB at T3 (P < 0.01).

Conclusions: Patients experienced a high degree of SPB in the early stage after stroke. Addressing the characteristics and predicting factors as well as the development of a targeted intervention for SPB may improve survival and post-stroke disability.

Introduction

Stroke is a major cause of long-term disability worldwide (1). It is the second commonest cause of death and the leading cause of adult disability in China (2). The Chinese National Stroke Registry reported that stroke occurred in more than 7 million Chinese people in 2011, and many survivors experienced persistent difficulty with daily tasks (3). The suffering caused by post-stroke residual disability has a devastating effect on the daily lives of patients and their families. Its associated health care expenditures are enormous to both the family and the national health care system (1, 4, 5). Stroke survivors, especially those with a disabling condition, regularly rely on the family's support to meet the demands of their daily lives. For some patients, the receiving care can lead to the sense of having become “a burden to others.” This sense of burden was referred to as “self-perceived burden” (SPB) (6).

SPB is defined as “empathic concern engendered from the impact on others of one's illness and care needs, resulting in guilt, distress, feelings of responsibility, and diminished sense of self” (6). McPherson found that medium to high levels of SPB were mentioned by 70.2% of stroke patients (7). In Zou's study, 91.54% of stroke patients with hemiplegia had SPB (8). The SPB is associated with patients' sociodemographic and clinical characteristics. It might differ among patients with different family financial conditions, medical expenses, functional status, and social supports (9, 10). Patients' SPB has a negative impact on their quality of life (QOL) (7). It is worth noting that patients with higher levels of SPB were less likely to seek help from others (6). The SPB may threaten individuals' coping and continued progress following stroke. Most studies, however, focused on the burden of caregivers of stroke survivors (11) or were cross-sectional studies (8–10). Despite existing evidence that SPB experienced by stroke patients affects stroke rehabilitation, emotional and mental health, and QOL, studies on the SPB of patients in the acute and recovery phase shortly after stroke are inadequate. Thus, this longitudinal study aimed at determining the levels of SPB experienced by stroke survivors during the first 3 months post-stroke and identifying influencing factors of SPB.