Anderson Jane A, Kimmel Barbara, Sansgiry Shubhada, Venkatasubba Rao Chethan P, Ovalle Anette P, Cerra-Stewart Colleen A, Kent Thomas A
Department of Medicine, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Department of Neurology, and Baylor College of Medicine, Houston, Texas, USA.
Telemed Rep. 2022 Sep 20;3(1):175-183. doi: 10.1089/tmr.2022.0026. eCollection 2022.
Patient self-management support (SMS) interventions help stroke survivors control stroke risk factors and assist with secondary prevention. We examined utility and preliminary effectiveness of mobile video-teleconferencing (VT) to deliver SMS to stroke survivors in rural and low-income urban Texas communities.
We applied a within-subjects design to assess improvement in self-management behaviors and stroke risk factors among stroke survivors receiving SMS intervention through mobile VT. Adults with stroke and two or more uncontrolled stroke risk factors were eligible. The SMS program, Video-teleconference-Self-management TO Prevent stroke (V-STOP) was delivered over 6 weeks by trained health coaches through VT. We applied Generalized Estimating Equations with site and time in intervention as covariates to evaluate psychological, social, physiological outcomes, self-management behaviors, and quality of life.
Mean age of 106 participants was 59.3 (±10.9); most were White, Hispanic men, living with someone, with low income. Approximately 69% completed all measures at 6 weeks. Median number of sessions attended was 5 (interquartile range 3) potentially avoiding 210 km of travel per person. Satisfaction with V-STOP and VT delivery was high, at (4.8 [±0.5]) and (4.7 [±0.5]), respectively. Stroke knowledge was improved from 8.8 (±1.0) at baseline to 9.6 (±0.7) at 12 weeks, ( < 0.0001). Improvements were observed in self-efficacy, exercise behaviors, depression and anxiety, disability, and quality of life.
Implementation of SMS is feasible and shows good utility and preliminary effectiveness of using mobile VT to provide stroke follow-up care to stroke survivors. Participants improved self-management behaviors and stroke risk factors.
患者自我管理支持（SMS）干预措施有助于中风幸存者控制中风风险因素，并辅助二级预防。我们研究了移动视频电话会议（VT）在德克萨斯州农村和低收入城市社区为中风幸存者提供SMS的效用和初步效果。
我们采用受试者内设计，评估通过移动VT接受SMS干预的中风幸存者在自我管理行为和中风风险因素方面的改善情况。患有中风且有两个或更多未得到控制的中风风险因素的成年人符合条件。由经过培训的健康教练通过VT在6周内提供SMS项目“预防中风的视频电话会议-自我管理”（V-STOP）。我们应用广义估计方程，将干预中的地点和时间作为协变量，以评估心理、社会、生理结果、自我管理行为和生活质量。
106名参与者的平均年龄为59.3岁（±10.9）；大多数是白人、西班牙裔男性，与他人同住，收入较低。约69%的人在6周时完成了所有测量。参加会议的中位数为5次（四分位间距为3次），每人可能避免了210公里的行程。对V-STOP和VT服务的满意度较高，分别为（4.8 [±0.5]）和（4.7 [±0.5]）。中风知识从基线时的8.8（±1.0）提高到12周时的9.6（±0.7），（P < 0.0001）。在自我效能、运动行为、抑郁和焦虑、残疾及生活质量方面均有改善。
实施SMS是可行的，并且显示出使用移动VT为中风幸存者提供中风后续护理具有良好的效用和初步效果。参与者改善了自我管理行为和中风风险因素。
