Examining a participation-focused stroke self-management intervention in a day rehabilitation setting: a quasi-experimental pilot study

Abstract

Background

People with stroke often find discharge from rehabilitation distressing because they do not feel prepared to participate in life roles as they want. A self-management approach can facilitate improvement in confidence and ability to manage post-stroke community living and participation after transitioning into the community.

Objective

To evaluate the feasibility and effectiveness of the Improving Participation After Stroke Self-management program – Rehab version (IPASS-R) in a day rehabilitation setting.

Methods

We used a mixed-method non-randomized quasi-experimental design. The IPASS-R program is a six-session group-based intervention led by a trained occupational therapist and lay person with stroke. The program uses an efficacy building approach to support aging adults to maintain active participation in home and community activities post-stroke. Primary outcome measures were the Reintegration to Normal Living Index (RNLI), Stroke Impact Scale (SIS), and Participation Strategies Self-Efficacy Scale. Qualitative feedback was collected post-treatment.

Results

Seventeen participants with stroke (intervention n = 9; control n = 8) were enrolled across two sites. Non-parametric effect sizes calculated using the Wilcoxon Signed-Rank test revealed larger effects on RNLI and SIS outcomes in the intervention group. The Mann–Whitney U test showed significant differences between the two groups’ changes in scores on perceived recovery and strength.

Conclusions

The result shows that IPASS-R has the potential to be integrated into a day rehabilitation setting with a positive impact on community integration and perceived recovery outcomes. Future study is needed to investigate the IPASS-R with a larger sample size and more rigorous study design.

Keywords:

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