title: Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial.
abstract: BACKGROUND
  Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management.
  
  
  OBJECTIVE
  To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery.
  
  
  METHODS
  This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups.
  
  
  RESULTS
  A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (allP<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, allP<0.05; Lawton, allP<0.001), compared to CG. The overall dropout rate was 16.7%.
  
  
  CONCLUSIONS
  Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.
authors: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories.
authors: Janet Wh
authors: JW
authors: Sit
authors: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories.
authors: Sek Ying
authors: SY
authors: Chair
authors: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories.
authors: Kai Chow
authors: KC
authors: Choi
authors: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories.
authors: Carmen Wh
authors: CW
authors: Chan
authors: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories.
authors: Diana Tf
authors: DT
authors: Lee
authors: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories.
authors: Aileen Wk
authors: AW
authors: Chan
authors: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories.
authors: Jo Lk
authors: JL
authors: Cheung
authors: Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong Hospital Authority, Causeway Bay, Hong Kong, People's Republic of China.
authors: Siu Wai
authors: SW
authors: Tang
authors: Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong Hospital Authority, Causeway Bay, Hong Kong, People's Republic of China.
authors: Po Shan
authors: PS
authors: Chan
authors: College of Nursing, The University of Arizona, Tucson, AZ, USA.
authors: Ruth E
authors: RE
authors: Taylor-Piliae
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010358:Patient Participation; D011788:Quality of Life; D020127:Recovery of Function; D012044:Regression Analysis; D012648:Self Care; D020377:Self Efficacy; D016037:Single-Blind Method; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000379:methods*; D017741:Survivors
keywords: activities of daily living; functional recovery; patient empowerment; rehabilitation; self-management; stroke