Wolf Timothy J, Baum Carolyn M, Lee Danbi, Hammel Joy
a Department of Occupational Therapy , University of Missouri , Columbia , MO , USA.
b Program in Occupational Therapy , Washington University School of Medicine , St. Louis , MO , USA.
Top Stroke Rehabil. 2016 Aug;23(4):284-92. doi: 10.1080/10749357.2016.1155278. Epub 2016 Mar 16.
There is a heavy emphasis in rehabilitation on restoration of function post-stroke at the expense of addressing how to manage the impact of stroke and the environment long term. Management of chronic health conditions is often and effectively addressed using self-management education; however, self-management is mostly focused on managing symptoms and health behaviors, not additional participation and community reintegration issues experienced following stroke. This study evaluated the Improving Participation after Stroke Self-Management Program (IPASS) to improve self-efficacy and participation in everyday life activities for individuals living with the long-term consequences of stroke.
A multisite, single-blind, exploratory randomized clinical study was conducted with participants with mild-to-moderate chronic stroke (n = 185). Participants were randomized either to receive the IPASS intervention immediately or to a wait list control group. The assessment was completed pre- and post-intervention and at 6-9 months post-intervention follow-up. The primary outcome assessments included measures of self-efficacy to manage chronic health conditions and to participate in everyday life activities.
The results show that there was significant short-term increase in health-related self-efficacy both within-group and between-groups in managing chronic conditions which were retained at follow-up; the average effect size was 0.46, indicating moderate effect overall. Further, a significant short-term increase was found in participation self-efficacy, with an overall moderate effect size of 0.55.
These results provide early support for the use of IPASS to help improve self-efficacy to manage health behaviors and to improve participation post-stroke. Further investigation is warranted to confirm these findings with an active control group and a more sensitive outcome measure to capture participation changes.
康复治疗非常重视中风后功能的恢复，却忽视了如何长期应对中风及其环境带来的影响。慢性健康问题的管理通常可通过自我管理教育得到有效解决；然而，自我管理大多侧重于症状和健康行为的管理，而非中风后出现的额外参与及重返社区等问题。本研究评估了中风后自我管理改善参与计划（IPASS），以提高中风长期影响患者的自我效能感及日常生活活动参与度。
对185名轻度至中度慢性中风患者进行了一项多中心、单盲、探索性随机临床研究。参与者被随机分为立即接受IPASS干预组或等待名单对照组。在干预前、干预后以及干预后6至9个月随访时完成评估。主要结局评估包括管理慢性健康问题及参与日常生活活动的自我效能感测量。
结果显示，在管理慢性疾病方面，组内和组间的健康相关自我效能感在短期内均有显著提高，且在随访时得以保持；平均效应大小为0.46，表明总体效果中等。此外，参与自我效能感在短期内也有显著提高，总体中等效应大小为0.55。
这些结果为使用IPASS帮助提高管理健康行为的自我效能感及改善中风后参与度提供了早期支持。有必要进行进一步调查，以通过一个积极对照组和更敏感的结局测量指标来证实这些发现，以捕捉参与度的变化。
