Post-stroke self-management interventions: a systematic review of effectiveness and investigation of the inclusion of stroke survivors with aphasia

Abstract

Purpose: To systematically review self-management interventions to determine their efficacy for people with stroke in relation to any health outcome and to establish whether stroke survivors with aphasia were included.

Method: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, The Cochrane Library, and IBSS and undertook gray literature searches. Randomized controlled trials were eligible if they included stroke survivors aged 18 + in a “self-management” intervention. Data were extracted by two independent researchers and included an assessment of methodological quality.

Results: 24 studies were identified. 11 out of 24 reported statistically significant benefits in favor of self-management. However, there were significant limitations in terms of methodological quality, and meta-analyses (n= 8 studies) showed no statistically significant benefit of self-management upon global disability and stroke-specific quality of life at 3 months or ADL at 3 or 6 months follow-up. A review of inclusion and exclusion criteria showed 11 out of 24 (46%) studies reported total or partial exclusion of stroke survivors with aphasia. Four out of 24 (17%) reported the number of stroke survivors with aphasia included. In nine studies (38%) it was unclear whether stroke survivors with aphasia were included or excluded.

Conclusions: Robust conclusions regarding the effectiveness of poststroke self-management approaches could not be drawn. Further trials are needed, these should clearly report the population included.

Implications for rehabilitation

• There is a lack of evidence to demonstrate the effectiveness of self-management approaches for stroke survivors.

• It is unclear whether self-management approaches are suitable for stroke survivors with aphasia, particularly those with moderate or severe aphasia.

• Further research is needed to understand the optimal timing for self-management in the stroke pathway and the format in which self-management support should be offered.

Keywords:

• Stroke
• self-management
• aphasia
• systematic review

Acknowledgements

With thanks to Jessica Hall, Farhat Mahmood and Jane Smith for help with citation screening and data extraction. Thanks also to Diedre Andre for help designing the search strategy.

Disclosure statement

The authors report no conflicts of interest

Additional information

Funding

This review was undertaken by the first author as part of a PhD project funded by the David and Anne Marie Marsden scholarship for stroke rehabilitation (University of Leeds).