Introduction:
Self-efficacy underpins a stroke survivor’s ability to self-manage their condition and can influence post-stroke recovery.
The aim of this systematic review was to synthesise the available evidence on the effectiveness of self-management programs for improving self-efficacy or health-related quality of life (HRQoL) in stroke survivors.
Methods:
Medline, EmCare, Scopus, CINAHL, Embase, PsycINFO, Web of Science, and Cochrane CENTRAL were searched for randomised controlled trials (RCTs) which measured the effects of self-management interventions for adults with stroke on self-efficacy and HRQoL. Data analysis was conducted using Stata (SE Version 18.0) for each outcome with sub-group meta-analysis using a random effect model.
Results:
From 13,490 abstracts screened, 41 trials involving 5,644 participants were included. Sample sizes of included studies ranged from 15 to 573, median time post-stroke ranged from 14 days to 3 years. Intervention doses ranged from 45 minutes to 72 hours. All studies investigated the effects of an intervention program containing more than one self-management component. Common components were information provision (n=34, 85%), goal-setting (n=31, 77.5%) and problem-solving (n=23, 57.5%).
There was no clear effect for self-management programs compared to no intervention on self-efficacy at 3 months (significant mean difference, SMD 0.18 [95% CI: -0.01 to 0.37]; 15 RCTs, n=1,220, low-certainty evidence) but a small improvement in HRQoL at 3 months (SMD 0.10 [95% CI 0.00 to 0.20], 14 RCTs, n=1,573, moderate-certainty evidence).
Conclusion:
Self-management programs varied markedly in content and dose. There is moderate-certainty evidence that self-management programs improve HRQoL but not self-efficacy at 3-months post program.