Group Support Promotes Self-Care for Stroke Patients

June 02, 2015

VIENNA, Austria — An innovative group program of rehabilitation and education encouraging self-care for patients who have stroke or transient ischemic attack (TIA) and their carers is boosting patients' confidence to re-engage in life and helping them to make lifestyle changes to lower their risk for a recurrent event.

The Acute stroke, Self-management support, Prevention, Information, Rehabilitation, Exercise (ASPIRE) program has been introduced at Yeovil District General Hospital in Somerset, United Kingdom, and consists of post-discharge group work for 2 hours for 12 weeks. Patients can come with spouses or carers and participate in interactive information sessions and individually tailored goal-orientated exercises.

A key and novel part of the program is the involvement of other stroke patients who have previously participated in the course as volunteers.

Peer-to-Peer Support

Presenting details of the ASPIRE program at the recent 24th European Stroke Conference (ESC), consultant therapist in rehabilitation Deborah Neal said the peer-to-peer support provided by other stroke patients helps the new patients build confidence and change their mindset so they better engage in healthy lifestyle behaviors.

She presented new data from the program showing that patients completing the course had a significant benefit in stroke knowledge and that scores for self-efficacy (confidence) also approached significance.

"Normally we wouldn't expect to see any major changes after just 12 two-hour sessions but because this program appears to bring about a change in mindset, the patients go home and change their behaviours," she commented. "One of the key elements that brings about this mindset change is the fact we have the 'expert' patients present. They act as role models. This is the theory of self-efficacy," she added. "It is a very cost-effective model."

Neal also noted that unlike some other group programs, the ASPIRE course is very inclusive. "We take everyone who has had a stroke — ischemic or hemorrhagic — or a TIA. We have no age or disability limits so we take people in wheelchairs and those who are fully mobile, and the whole spectrum of communication and cognition. They all receive an individually tailored exercise program."

The course is run by a physiotherapist, a nurse, and a rehab assistant, with guest speakers including a pharmacist, dietitian, and occupational therapist. Then the patient volunteers and carers add more support.

"We find friendships build up and patients become empowered by each other to follow healthy behaviors outside the program. For example, they may join a local walking group or gym together," Neal said. "We also run a buddy system, putting new patients in touch with others who have been through the program who may live locally to them. In this way we are setting up a stroke community where good habits are spread by the patients themselves. The social interaction itself also helps enormously."

"Drip, Drip, Drip" Approach

Neal noted that before ASPIRE was established, about half the stroke patients in the area were going home without any rehabilitation or regular follow up. "We found that people were still in shock — many hardly recognized that they had had a stroke, but they were at high risk of having another one if they didn't change their lifestyle. They are told at the hospital about risk factors but most don't remember. But our 12-week 'drip, drip, drip' approach is much more effective at getting the messages across."

The weekly sessions also act as a point of contact for previous patients to "drop in" for further advice. Carers also get the chance for some respite if they prefer not to stay at the sessions.

Neal notes that this approach will be difficult to validate in a randomized trial because the program is very pragmatic and heavily individualized. So they are looking at qualitative data instead.

"The number needed to treat in terms of a benefit on mortality or recurrent stroke will be high but effects on confidence and quality of life will be much more obvious and easier to demonstrate," she said.

The current analysis involved two phases In the first, 10 patients attending the program and 7 carers (all spouses) were interviewed about three major outcomes: confidence in doing important everyday activities, developing knowledge for reducing vascular risk, and the benefits of peer support.

The second phase tested the phase 1 outcomes in 19 patients and 6 carers using relevant standardized validated tools, including the Stroke Knowledge Test, the Stroke Self-Efficacy Questionnaire, the Hospital Anxiety and Depression Scale, and the Caregiver Strain Index.

24th European Stroke Conference (ESC). Presented May 14, 2015.

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