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

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, July 28, 2021

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 Chen¹^†,

Yuanyuan Wei²^†,

Hongjuan Lang¹,

Ting Xiao¹,

Yan Hua¹,

Lu Li³,

Jing Wang¹,

Hongxia Guo⁴^*^‡ and

Chunping Ni¹^*^‡

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.