Examining the feasibility and effectiveness of a culturally adapted participation-focused stroke self-management program in a day-rehabilitation setting: A randomized pilot study

ABSTRACT

Background: Stroke survivors find it difficult to participate in daily activities, despite their improvement throughout the rehabilitation process. Thus, it has been questioned whether day-rehabilitation services provide adequate preparation for participation and reintegration into the community. Self-management programs can improve survivors’ self-efficacy to manage their condition and participation. Improving Participation After Stroke Self-Management program (IPASS) is an occupational therapy-based group intervention developed in the United States, which has been effective in improving participation outcomes.

Objective: To evaluate the feasibility and effectiveness of the IPASS adapted for an Israeli population of individuals admitted to a day-rehabilitation center after stroke.

Methods: A single-center, randomized, assessor-blind study was conducted. Eligible participants were randomized to receive the IPASS (intervention group), in addition to standard individual therapy or standard care only (control group). Feasibility was based on attendance rate and a feedback questionnaire. Effectiveness was evaluated with the Functional Independence Measure (FIM), the Reintegration to Normal Living Index (RNLI) and self-efficacy questionnaires.

Results: Sixty participants were included, of which 39 completed baseline and post-intervention evaluations. The intervention group improved significantly in the FIM scores (p < .01), as compared to the control group (p > .05). Moderate effect sizes (≥0.35) were found for the FIM and RNLI, and large effect sizes (≥0.65) for two subcategories in the participation self-efficacy questionnaire.

Conclusions: The results support the feasibility of the adapted IPASS, and show a trend for positive effects in improving participation and self-efficacy in managing participation in home and community activities, for an Israeli post-stroke population.

KEYWORDS:

• Stroke
• participation
• self-management
• occupational therapy
• rehabilitation

Acknowledgments

The authors wish to thank Dana Hadar for her contribution to the statistical analyses of the study, to the research assistant and to the participants for their involvement in the study.

Ethics approval

The study was approved by the Ethics Committee of Clalit Health Services under the number 0018-14-COM in November 2014. All participants provided written informed consent.

The study was registered in the U.S. National Institutes of Health clinical trials registry. Registration number: NCT02289287.

Additional information

Funding

This study was partly sponsored by a scholarship from the “Foundation for promoting the Research of Aging” of University of Haifa and JDC Israel, and by an excellence scholarship for PhD candidates from the Graduate Research Authority of University of Haifa, Israel.