Process evaluation of the Restore4stroke Self-Management intervention 'Plan Ahead!': a stroke-specific self-management intervention.

OBJECTIVE: To investigate whether the self-management intervention was implemented as intended. Additionally, we studied involvement in and satisfaction with the intervention among patients, their partners and therapists. DESIGN: Mixed method, prospective study. SETTING: Outpatient facilities of hospitals/rehabilitation centres. PARTICIPANTS: Stroke patients, their partners and therapists from the experimental arm of the Restore4Stroke Self-Management study. INTERVENTION: 'Plan Ahead!' is a 10-week self-management intervention for stroke patients and partners, consisting of seven two-hour group sessions. Proactive action planning, education and peer support are main elements of this intervention. MAIN MEASURES: Session logs, questionnaires for therapists, patients and their partners, and focus groups. DATA ANALYSIS: Qualitative data were analysed with thematic analysis supplemented by quasi-statistics. Quantitative data were reported as descriptive statistics. RESULTS: The study sample consisted of 53 patients and 26 partners taking part in the intervention, and all therapists delivering the intervention (N = 19). At least three-quarters of the intervention sessions were attended by 33 patients and 24 partners. On a scale from 1 to 10, patients, partners and therapists rated the intervention with mean scores of 7.5 (SD1.6), 7.8 (SD.7) and 7.4 (SD.7), respectively. Peer support was the most frequently appreciated element for participants and therapists. The proactive action planning tool was adequately applied in 76 of the 96 sessions. CONCLUSION: Although the target audience was reached and both participants and therapists were satisfied with the intervention, the proactive action planning tool that distinguishes the current intervention from existing stroke-specific self-management interventions was only partly implemented according to protocol.

Effectiveness of the Restore4Stroke self-management intervention "Plan ahead!": A randomized controlled trial in stroke patients and partners.

OBJECTIVE: To investigate the effectiveness of a self-management intervention aimed at proactive coping for stroke patients and partners, compared with an education intervention. DESIGN: Multicentre randomized controlled trial. PARTICIPANTS: The study included 113 stroke patients (mean age 57.0 years (standard deviation (SD) 9.0), mean 18.8 months after stroke (SD 28.4)) and 57 partners (mean age 59.2 years (SD 8.3)). METHODS: Participants were randomized to a self-management intervention, or an education intervention, both 10 weeks' duration, outpatient, stroke-specific, and group-based. Main patient inclusion criteria were symptomatic stroke (≥ 6 weeks previously) and reporting ≥ 2 restrictions on the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation Participation. Measurements were performed immediately after intervention, and at 3 and 9 months follow-up. Primary patient and partner outcomes were proactive coping and participation restrictions. Analyses were based on linear mixed modelling. RESULTS: A significant effect was found only in partners' increased proactive coping at T2 (compared with education intervention). Beneficial trends were found for the self-manage-ment intervention in partners' self-efficacy and patients' health-related quality of life, mood complaints and participation restriction. CONCLUSION: Little convincing evidence was found favouring our self-management intervention over the education intervention; therefore, the self-management intervention should not be implemented yet in clinical practice. Further research is needed to explore beneficial trends.

Associations of proactive coping and self-efficacy with psychosocial outcomes in individuals after stroke.

OBJECTIVE: To examine the associations of proactive coping and self-efficacy with psychosocial outcomes in individuals after stroke. DESIGN: Cross-sectional study. Regression analyses were performed. SETTING: Outpatient settings of hospitals and rehabilitation centers. PARTICIPANTS: Individuals after stroke (N=112; mean age ± SD, 57.1±8.9y; mean time ± SD since stroke, 18.9±28.5mo). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Proactive coping was measured using the Utrecht Proactive Coping Competence scale (UPCC), and self-efficacy was measured using the General Self-Efficacy Scale (GSES). Psychosocial outcomes were measured as (1) participation with the use of the restriction and satisfaction subscales of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation); (2) emotional problems with the use of the Hospital Anxiety and Depression Scale (HADS); (3) life satisfaction with the use of 2 questions (2LS); and (4) health-related quality of life (HRQOL) with the use of the Short Stroke-Specific Quality of Life scale (SS-QOL-12). RESULTS: Higher UPCC scores were associated with lower HADS scores (ß=-.55, P<.001) and with higher USER-Participation satisfaction (ß=.31, P=.001), 2LS (ß=.34, P<.001), and SS-QOL-12 scores (ß=.44, P<.001). The influence of UPCC scores on HRQOL was indirect through self-efficacy. Higher GSES scores were associated with higher UPCC scores (ß=.65, P<.001), which in turn were associated with lower HADS scores (ß=-.51, P<.001). GSES scores were directly associated with higher SS-QOL-12 scores (ß=.32, P=.002). GSES scores did not influence the association between UPCC scores and any of the psychosocial outcomes (all P>.0025). CONCLUSIONS: Proactive coping and self-efficacy have different associations with each of the psychosocial outcomes. Therefore, outcome-specific models appear to be necessary to describe these associations.

The Restore4Stroke self-management intervention 'Plan ahead!': rationale and description of the treatment protocol based on proactive action planning.

OBJECTIVE: To describe the rationale behind and description of a group-based self-management intervention developed for stroke patients and their partners. RATIONALE: Based on the assumption that proactive coping strategies are beneficial for the re-uptake of daily life by stroke patients and partners, we developed a new stroke-specific, group-based self-management intervention based on proactive action planning. A first concept of the treatment protocol was developed based on the proactive coping theory, the Health Action Process Approach model, existing interventions and expert consultations. Further adjustments were based on two pilot studies, including addition of solution-based therapeutic techniques. DESCRIPTION OF THE INTERVENTION: 'Plan ahead!' is a 10-week group-based self-management intervention, consisting of six 2-hour sessions in the first six weeks and a 2-hour booster session in the 10th week. It is offered in an outpatient setting by two rehabilitation professionals with experience in group counselling and working with stroke patients. It is provided to groups of four stroke patients living at home (stroke ≥2 months ago) and their partners. The main features are (1) proactive action planning as the main constituent, (2) stroke-specific elements and (3) considering partners as full participants. DISCUSSION: This stroke-specific intervention is expected to increase the use of proactive action planning and thus improve the participation of stroke patients and their partners. It is innovative in its aim to change behaviour patterns of participants directly, teaching participants a general action planning strategy and considering partners as full participants with their own goals and opportunities.

Study protocol of the Restore4Stroke self-management study: a multicenter randomized controlled trial in stroke patients and their partners.

RATIONALE: Many stroke patients and their partners report long-term negative consequences of stroke on their health-related quality of life. Adequate self-management abilities may help manage the consequences of the stroke, but it is unknown what specific intervention might be effective to enhance self-management abilities of stroke patients and their partners. AIM: The study aims to investigate the effectiveness of a 10-week group self-management intervention addressing proactive coping strategies compared with a group education intervention in stroke patients and their partners. DESIGN: The study is a multicenter randomized controlled trial. A total of 106 stroke patients with, if applicable, their partners are randomly assigned to the self-management intervention or the education intervention within each of the 10 participating hospitals and rehabilitation centers. The main inclusion criteria are a symptomatic stroke at least six-weeks ago, living at home, and reporting at least two participation restrictions on the Utrecht Scale for Evaluation of Rehabilitation-Participation's restriction scale. Measurements are performed at baseline, immediately after intervention, three-months, and nine-months postintervention. STUDY OUTCOMES: Primary outcome measures are stroke patients' and partners' proactive coping competencies (Proactive Competence Inventory) and societal participation (Utrecht Scale for Evaluation of Rehabilitation-Participation's restriction scale). DISCUSSION: If effective, the results of this study will enable stroke patients and their partners to deal better with the lasting consequences of stroke. In the context of the growing number of people returning home after stroke, a large number of people may profit from this intervention.

Proactive coping poststroke: psychometric properties of the Utrecht Proactive Coping Competence Scale.

OBJECTIVE: To examine psychometric properties of the Utrecht Proactive Coping Competence scale (UPCC) and explore relations of proactive coping with health-related quality of life (HRQOL) and characteristics of patients with stroke. DESIGN: Cross-sectional study. Reliability and convergent validity, and associations with HRQOL and characteristics of patients with stroke were examined. SETTING: Inpatient and outpatient settings of hospitals and rehabilitation centers in The Netherlands. PARTICIPANTS: Patients with stroke (N=55; mean age, 58.7±12.8y; mean months since stroke, 25.0± 38.5). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: UPCC, Utrecht Coping List (UCL), and the short Stroke Specific Quality of Life scale (SS-QOL-12). RESULTS: The UPCC showed excellent reliability (Cronbach's α=.95) without floor/ceiling effects or skewed score distribution. Convergent validity was shown by moderate positive relations with the UCL subscale active problem solving (r=.38) and moderate negative relations with the UCL subscales passive reactions (r=-.50), avoidance (r=-.40), and expression of emotions (r=-.42). Correlations between the UPCC and HRQOL domains were moderate to strong (r=.48-.61) and stronger than those between UCL subscales and HRQOL domains. The only characteristic of patients with stroke associated with proactive coping was time after stroke (r=-.52). CONCLUSIONS: The UPCC appears reliable and valid for patients with stroke. Moreover, we found positive associations between proactive coping and HRQOL. Future research is recommended to confirm our results and to explore ways to enhance proactive coping in patients with stroke.

Facilitation of memory by contextual cues in patients with diencephalic or medial temporal lobe dysfunction.

Item-context binding is crucial for successful episodic memory formation, and binding deficits have been suggested to underlie episodic-memory deficits. Here, our research investigated the facilitation of cued recall and recognition memory by contextual cues in 20 patients with Korsakoff's amnesia, 20 unilateral medial-temporal lobectomy (MTL) patients and 36 healthy controls. In a computerized task participants had to learn 40 nouns that were randomly combined with a photograph of an everyday scene. Korsakoff patients showed a general memory deficit in both the cued recall and the recognition condition. A less severe memory impairment was found in the patients with medial-temporal lobectomy. Contextual cues facilitated cued recall to an equal extent in unilateral temporal lobectomy patients and healthy controls. However, no facilitation was observed in Korsakoff patients, suggesting an impairment in item-context binding during cued recall tasks. In contrast to the presumed exclusive dependency of recognition memory on item information, all groups equally profited from the contextual cues in recognition tasks. Our findings show that unilateral lesions as with MTL result in normal binding of context and item information, while bilateral dysfunction of the hippocampal-diencephalic system results in impaired context and item binding.