McKenna Suzanne, Jones Fiona, Glenfield Pauline, Lennon Sheila
School of Health Sciences, Health and Rehabilitation Sciences Research Centre, University of Ulster, Newtownabbey, UK.
Faculty of Health & Social Care, St George's University of London and Kingston University, London, UK.
Int J Stroke. 2015 Jul;10(5):697-704. doi: 10.1111/ijs.12195. Epub 2013 Nov 21.
Enabling self-management behaviors is considered important in order to develop coping strategies and confidence for managing life with a long-term condition. However, there is limited research into stroke-specific self-management interventions.
The aim of this randomized controlled trial was to evaluate the feasibility of delivering the Bridges stroke self-management program in addition to usual stroke rehabilitation compared with usual rehabilitation only.
Participants recruited from the referrals to a community stroke team were randomly allocated to the Bridges stroke self-management program, receiving either one session of up to one-hour per week over a six-week period in addition to usual stroke rehabilitation, or usual rehabilitation only. Feasibility was measured using a range of methods to determine recruitment and retention; adherence to the program; suitability and variability of outcome measures used; application and fidelity of the program; and acceptability of the program to patients, carers and professionals.
Twenty-five people were recruited to the study over a 13-month period. Eight out of the 12 participants in the Bridges stroke self-management program received all six sessions; there was one withdrawal from the study. There were changes in outcomes between the two groups. Participants who received the Bridges stroke self-management program appeared to have a greater change in self-efficacy, functional activity, social integration and quality of life over the six-week intervention period and showed less decline in mood and quality of life at the three-month follow-up. Professionals found the program acceptable to use in practice, and feedback from participants was broadly positive.
The findings from this study appear promising, but questions remain regarding the feasibility of delivering the Bridges stroke self-management program in addition to usual rehabilitation. The dose response of receiving the program cannot be ruled out, and the next stage of research should explore the feasibility of an integrated program. Exploration of the reasons behind relatively low recruitment and of the sensitivity of outcome measures to detect a change are also required. Additional investigation of intervention fidelity is required to monitor if the program is being delivered as intended.
为了制定应对策略并增强应对长期疾病生活的信心，促使自我管理行为被认为很重要。然而，针对中风特异性自我管理干预措施的研究有限。
这项随机对照试验的目的是评估在常规中风康复基础上实施“桥梁”中风自我管理项目相较于仅进行常规康复的可行性。
从转介至社区中风团队的患者中招募参与者，将其随机分配至“桥梁”中风自我管理项目组，该组除接受常规中风康复外，在六周时间内每周接受一次时长可达一小时的课程，另一组则仅接受常规康复。通过一系列方法来衡量可行性，包括确定招募和留存情况；对项目的依从性；所使用结局指标的适用性和变异性；项目的实施和保真度；以及该项目对患者、护理人员和专业人员的可接受性。
在13个月期间有25人被招募到该研究中。“桥梁”中风自我管理项目组的12名参与者中有8人接受了全部六次课程；有1人退出研究。两组之间的结局存在变化。接受“桥梁”中风自我管理项目的参与者在六周干预期内自我效能感、功能活动、社会融入和生活质量方面的变化似乎更大，并且在三个月随访时情绪和生活质量的下降幅度更小。专业人员认为该项目在实践中可接受，参与者的反馈总体上是积极的。
本研究结果似乎很有前景，但在常规康复之外实施“桥梁”中风自我管理项目的可行性仍存在问题。不能排除接受该项目的剂量反应，下一阶段的研究应探索综合项目的可行性。还需要探究招募率相对较低的原因以及结局指标检测变化的敏感性。需要对干预保真度进行额外调查，以监测该项目是否按预期实施。
