A scoping review of therapies targeting confidence in stroke survivors

Figures & data

Figure 1. PRISMA Flow diagram showing the identification, screening, and selection of studies.

Table 1. Summary of included studies based on intervention then chronological order.

Therapy Grouping	#	Author and year of publication	Description of study intervention	Participant diagnosis and sample size	Study type	Outcome measure	Confidence Outcome
SE	1	(Jones et al., 2009)*	The development of a self-management intervention workbook based on Bandura’s principles of self-efficacy for stroke survivors (A. Bandura, 1977). Content contained examples of high levels of self-efficacy, activities, practical solutions, and a diary section to record personal goals and experiences.	Stroke (n = 10)	Preliminary study	Stroke Self-efficacy Questionnaire, General Self-efficacy Scale	Improved
SE	2	(Jones et al., 2016)	The effectiveness of a self-management intervention workbook (Jones et al., 2008).	Stroke (n = 78)	Feasibility study	Stroke Self-Efficacy Questionnaire	Improved
SE	3	(Lo et al., 2019)	Protocol for an enhanced stroke self-management programme (Coaching Ongoing Momentum Building On stroKe rEcovery journeY [COMBO-KEY], underpinned by Bandura’s principles for self-efficacy (A. Bandura, 1977). The use of home visits and telephone coaching sessions to apply strategies to enhance self-efficacy with the support of a resource package. Participants select a personalized short-term goal and prepare an action plan that will be followed-up on and facilitated by the phone coaching sessions.	Stroke (n = 134)	Protocol	Stroke Self-Efficacy Questionnaire	NA
SE	4	(Lo et al., 2021)	A narrative and skills building intervention (NSI) aimed to reintegrate stroke-survivors into their social roles through narratives and skill building. Narratives aimed to increase awareness and promote ownership of current post-stroke identity. Skill-building focused on enhancing self-efficacy through “mastery, modelling, persuasion and reinterpretation of physical and emotional arousal” (Lo et al., 2021). A component of self-management was also an integral part of the skills targeted in this intervention for goal setting, action planning, decision making, seeking out information and communicating.	Stroke (n = 208)	Protocol for a randomised controlled trial	Chinese version of the Stroke Self-Efficacy Questionnaire	NA
SE	5	(Adamit et al., 2023)	Functional and Cognitive Occupational Therapy (FaCoT) taught and practiced cognitive and behavioural strategies through the training on personally identified functional goals in line with Bandura’s principles.	Stroke (n = 66)	Single-blind, randomized controlled trial	The New General Self-Efficacy Scale (NGSE), The ‘Perception of Self’ subscale of the Reintegration to Normal Living Index (RNLI)	Improved
SE	6	(Osei et al., 2023)*	Personalised interventional support delivered by stroke nurses in the domains of cognitive rehabilitation, physical rehabilitation, emotional support, and stroke education. Topics include establishing a structured routine, using memory aids, recognizing emotions and mood changes and identifying personalized coping strategies.	Stroke (n = 40)	Protocol for a pilot randomized feasibility trial	Stroke Self Efficacy Questionnaire	NA
SE	7	(Smith et al., 2023)	Behaviour change group -based sessions to promote secondary stroke prevention.	Stroke (n = 118)	Protocol	7-point scale with four items to measure confidence	NA
IB	8	(Rodriguez et al., 2013)	Aphasia Language Impairment and Functioning Therapy (LIFT) was based on principals of neuroplasticity. Therapy was individualized to address each participant’s personalized goal based on their language level. The therapy programme comprised of individual impairment-based and functional treatment, group therapy, and computer-based treatment.	Aphasia (n = 11)	Exploratory investigation	The Quality of Communication Life Scale	Improved
IB	9	(Young et al., 2013)	Conducted interviews with participants from the ACT NoW study that received an early, enhanced speech and language therapy after stroke. Interview methods incorporated multiple aids such as prompt cards, pictorial representations, and visual analogue scales. Participants valued the amount of contact and personalized relevance of interactions during the experience. An increase in confidence was also identified as a positive outcome.	Stroke (n = 22)	Qualitative study nested within a randomized controlled trial	Qualitative	Enhanced
IB	10	(Dignam et al., 2015)	Over the duration of 3 weeks, participants received 48 hours of therapy distributed between impairment therapy, functional therapy, computer-based therapy, and group therapy.	Aphasia (n = 34)	Nonrandomized, Parallel-Group, Dosage-Controlled Study	Communication Confidence Rating Scale for Aphasia	Improved
IB	11	(Grasso et al., 2019)	Lexical Retrieval Cascade Treatment where caregivers were trained by a speech-language therapist to apply therapy. Therapy consisted of a task hierarchy that supported the use of self-cuing to facilitate word retrieval through utilizing spared semantic, orthographic, and phonological skills.	Anomia (n = 2 dyads)	Comparison study	Qualitative	Improved
SM	12	(Kendall et al., 2007)	Psychosocial skills intervention that used an existing self-management intervention, The Chronic Disease Self-Management Course (Lorig et al., 2001). Group sessions covered topics related to health and well-being in an interactive and supportive atmosphere.	Stroke (n = 100)	Longitudinal randomized controlled trial	Self-efficacy scale	No changes
SM	13	(McKenna et al., 2015)	Bridges, a stroke self-management program. Ongoing rehabilitation was supplemented with structured sessions aimed to promote behaviours that facilitate self-management. A workbook reinforced self-management behaviours by providing examples of successful self-management from other stroke survivors and allowed self-reflection through the documentation of personal goals and progress.	Stroke (n = 25)	A feasibility randomized controlled trial	Self-Efficacy Scale (SES), Stroke Self-Efficacy Questionnaire (SSEQ)	Improved
SM	14	(Lo et al., 2023)	Online platform that supports stroke survivors through providing routine consultations and check-ins in addition to video material pertaining to rehabilitation and stroke care for sufficient self-management.	Stroke (n = 384)	Randomized Controlled Trial	Chinese version of the Stroke Self-Efficacy Questionnaire	Improved
Tech	15	(Cherney & Halper, 2008)	The use of “AphasiaScripts”, a computerized software for conversational script training for people with aphasia. Practice on individualized scripts was completed at home. The clinician’s role was to monitor practice and assess progress.	Aphasia (n = 3)	Case studies	Qualitative	Improved
Tech	16	(Palmer et al., 2013)	Conducted interviews that investigated acceptability and experiences with an independent, self-managed at-home computerized aphasia therapy “StepbyStep”. Therapy included general language stimulation activities, attendance of communication support groups, and daily communicative tasks that require reading, writing and conversational skills in addition to using the “StepbyStep” program. Computerized therapy focused on word finding and production with a customization option for personally relevant words.	Aphasia (n = 24)	Acceptability study alongside a pilot randomized control trial	Qualitative	Improved
Tech	17	(Wentink et al., 2016)	Implementation of a computer-based brain training program through gaming. Computer games targeted five cognitive domains: attention, speed, memory, flexibility, and problem solving. Feedback was provided after the completion of each 3-game session and participants could access the games outside training sessions. Level of difficulty altered based on performance. No significant changes in SE were reported.	Stroke (n = 107)	Randomized control trial	General Self-Efficacy Scale	No changes
Tech	18	(Poulin et al., 2017)	Compared two interventions for individuals with executive dysfunction: an occupation-based training and a computer-based training. The Cognitive Orientation to daily Occupational Performance (CO-OP) approach combined individualized goals, problem-solving strategies, performance analysis and specified strategy applications. The computer training approach contained computerized activities with varying executive functional demands such as working memory, cognitive flexibility, divided attention, and inhibition.	Stroke (n = 11)	Pilot study	The Self-Efficacy Scale for Performing Life Activities Post-Stroke	Improved
Tech	19	(Amaya et al., 2018)	Determined views and impact of an intervention based in virtual reality (VR), “EVA Park”, where stroke survivors with aphasia interacted with support workers, therapists, and each other. In addition to therapy sessions conducted in VR, users had unlimited access to this virtual island.	Aphasia (n = 20)	Qualitative interview study	Qualitative	Improved
Tech	20	(Meltzer et al., 2018)	Compared in-person to tele-rehabilitation therapy delivery modes. Tele-rehabilitation consisted of therapy sessions delivered using a tele-conferencing platform. Weekly speech and language therapy sessions focused on communication partner training techniques and structured conversational exercises. “TalkPath” – an application with various speech and language exercises was used for home training.	Aphasia (n = 44)	Non-inferiority study	Communication Confidence Rating Scale for Aphasia (CCRSA)	Improved
Tech	21	(Caute et al., 2019)	Implemented a technology-enhanced reading therapy that incorporated the use of mainstream assistive reading technologies with reading strategies. The assistive technologies allowed users to edit visual aspects of texts and provided dictionary support. The reading therapy focused on individual reading therapy goals that were identified beforehand. Therapy sessions covered technology troubleshooting, review of completed readings, active reading using the support of the assistive reading technology and setting reading goals for next session.	Aphasia (n = 21)	Quasirandomized Waitlist Controlled Study	Reading Confidence and Emotions Questionnaire	Improved
NR	22	(Lesser & Watt, 1978)	Discussed a community-based club for people with aphasia, the Newcastle Speech-After-Stroke Project. Interactions between stroke survivors and ‘helpers’ were guided by recommendations to create naturalistic conversations, encourage communication, give supportive feedback and social confidence when completing daily tasks. The club members met weekly, and activities were determined by club members, these included discussing the news, playing language games or an outing. Home visits were provided if welcomed.	Aphasia (n = 16)	Experimental study	Qualitative	Improved
NR	23	(Cherney et al., 2011)	Used drama therapy principles to allow participants with aphasia to write and produce a play that reflects their experiences with aphasia. The drama therapy process had four stages: encountering, exploring, elaborating, and preserving the theatre experience.	Aphasia (n = 7)	Experimental study	Communication Confidence Rating Scale	Improved
NR	24	(Ryan et al., 2017)	Aphasia Action, Success, and Knowledge (Aphasia ASK) programme consisted of sequential sessions; an introduction, goal setting session, a selection of communication related sessions followed by a goal review and summary session. Communication related sessions were determined by the therapist and participant.	Aphasia (n = 7)	Convergent parallel mixed methods study	Communication Confidence Rating Scale in Aphasia	Improved
NR	25	(Horne et al., 2019)*	Group therapy sessions that followed the Regaining Confidence After Stroke – RCAS topics (Townsend, 2009). Topics covered are relevant to stroke survivors, such as emotions, problems, and management. Final sessions focused on coping and confidence. Carers were invited to join specific sessions.	Stroke (n = 47)	Feasibility randomised controlled trial	Confidence after Stroke Measure (CaSM)	Improved
NR	26	(Gual et al., 2020)	Used MI as a method to enhance the participation of stroke survivors in their care management. MI included open ended questions, positive affirmations, reflective listening, summarization, and advice when permitted. MI content included the exploration of preferences, values, and goals in addition to knowledge regarding stroke rehabilitation and outcomes.	Stroke (n = 272)	Study protocol of a randomized clinical trial	General Self-Efficacy scale	NA

Notes: *Confidence/Self-efficacy was the primary aim of the intervention

Sequence of studies in current Table 1 match the sequence represented in Table 4.

Abbreviations: SE, Self-efficacy; IB, Impairment-based/ Symptom focused intervention studies; SM, Self-Management; Tech, Technology; NR, Non-recurring.

Table 2. Summary of study groupings.

Category	Criteria	Number of studies
Impairment-based or symptom-focused treatments	Studies that reported the main goal of treatment was remediating a specific skill, with measurement of confidence as a secondary outcome.	4
Self-efficacy approaches	Studies that reported using “self-efficacy” as the main underpinning approach to their therapy.	7
Self-management interventions	Studies that reported the main aim of intervention is “self-management”.	3
Technology	Studies that reported either delivering therapy using a digital means or supplementing face to face or group treatment with technology for further training.	7
Non-recurring approaches	Studies that reported therapy approaches or frameworks that only appeared once within the included studies.	5

Table 3. Quantitative confidence/self-efficacy outcome measures reported.

Confidence/self-efficacy tool	Number of times used in studies
Stroke Self-efficacy Questionnaire	5
Communication Confidence Rating Scale for Aphasia	4
General Self-efficacy Scale	3
Chinese version of the Stroke Self-Efficacy Questionnaire	2
Self-efficacy scale	2
7-point scale with four items to measure confidence	1
Confidence after Stroke Measure	1
Reading Confidence and Emotions Questionnaire	1
The New General Self-Efficacy Scale	1
The “Perception of Self” subscale of the Reintegration to Normal Living Index	1
The Self-Efficacy Scale for Performing Life Activities Post-Stroke	1
The Quality of Communication Life Scale	1

Table 4. Components of study interventions.

	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24	25	26
	(Jones et al., 2009)	(Jones et al., 2016)	(Lo et al., 2019)	(Lo et al., 2021)	(Adamit et al., 2023)	(Osei et al., 2023)	(Smith et al., 2023)	(Rodriguez et al., 2013)	(Young et al., 2013)	(Dignam et al., 2015)	(Grasso et al., 2019)	(Kendall et al., 2007)	(McKenna et al., 2015)	(Lo et al., 2023)	(Cherney & Halper, 2008)	(Palmer et al., 2013)	(Wentink et al., 2016)	(Poulin et al., 2017)	(Amaya et al., 2018)	(Meltzer et al., 2018)	(Caute et al., 2019)	(Lesser & Watt, 1978)	(Cherney et al., 2011)	(Ryan et al., 2017)	(Horne et al., 2019)	(Gual et al., 2020)
Self-Efficacy	+	+	+	+	+	+	+							+
Intensive therapy								+		+
Impairment-based treatment								+	+	+	+
Technology			+			+	+	+		+				+	+	+	+	+	+	+	+
Computer administered^a															+	+	+	+
Computer assisted ^b							+	+		+									+		+
Tele-health ^c			+			+	+							+					+	+
Individual sessions			+	+	+	+	+	+		+	+		+							+	+	+		+		+
Group sessions							+	+		+		+		+								+	+		+
Workbook	+	+	+		+		+						+					+
Home assignments					+		+				+				+					+	+
Self-management	+	+		+								+	+	+		+										+
External aid ^d	+	+												+

Notes: a. Computer-administered: Therapy was fully delivered by a computer, b. Computer-assisted: Therapy was supplemented by a computer, either as part of a therapy package or to display stimuli for therapy, c. Tele-health: Therapy was delivered by a human using telecommunications technology, d. External aid: Additional assistive aids (e.g., notebook, calendar etc.). Sequence of studies in current Table 4 match the sequence represented in Table 1.

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