title: The Development of the Improving Participation after Stroke Self-Management Program (IPASS): An Exploratory Randomized Clinical Study.
abstract: 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.
authors.affiliation: a Department of Occupational Therapy , University of Missouri , Columbia , MO , USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wolf
authors.affiliation: b Program in Occupational Therapy , Washington University School of Medicine , St. Louis , MO , USA.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Baum
authors.affiliation: c Department of Occupational Therapy , University of Illinois at Chicago , Chicago , IL , USA.
authors.forename: Danbi
authors.initials: D
authors.lastname: Lee
authors.affiliation: c Department of Occupational Therapy , University of Illinois at Chicago , Chicago , IL , USA.
authors.forename: Joy
authors.initials: J
authors.lastname: Hammel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D000073278:Self-Management / Q000379:methods*; D016037:Single-Blind Method; D058992:Social Participation; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000379:methods*
keywords: Occupational therapy; Participation; Self-management; Stroke