Oral Presentation Asia Pacific Stroke Conference 2024

Do self-management programs improve self-efficacy or health-related quality of life after stroke? A systematic review (107507)

Elizabeth Lynch 1 , Katie Nesbitt 1 , Unyime Jasper 1 , Aarti Gulyani 2 , Liam Allan 3 , Rebecca Barnden 3 , Emily Brogan 4 5 , Lemma Bulto 1 , Dominique Cadilhac 3 , Raymond Chan 1 , Erin Godecke 6 , Thoshenthri Kandasamy 1 , Fiona Jones 7 , Stacy Larcombe 1 , Coralie English 8
  1. Flinders University, Adelaide
  2. Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
  3. Monash University, Melbourne
  4. Pathology Department Fiona Stanley Hospital group, Perth
  5. Curtin University, Perth
  6. Edith Cowan University, JOONDALUP
  7. Kings College London, London
  8. University of Newcastle, Newcastle

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.