Changing self-efficacy in individuals following a first time stroke: preliminary study of a novel self-management intervention

Objective: To examine the effects of a self-management workbook intervention designed for use with individuals disabled after first time stroke. Design: Multiple-participant two-phase (baseline followed by treatment) single subject design. The intervention was introduced at a randomly generated time-point. Setting: Community. Subjects: Seven men and three women, with a mean age of 61.5 years (SD 8.15), on average 24.2 weeks (SD 18.29) following first stroke, all with residual restriction of activity and participation. Intervention: An individualized self-management workbook based on self-efficacy principles, incorporating sections to increase mastery, vicarious experience and feedback. Main measures: Stroke Self-Efficacy Questionnaire, General Self-Efficacy Scale, Recovery Locus of Control Scale, Rivermead Mobility Index, Rivermead Activities of Daily Living Scale, Subjective Index of Physical and Social Outcome and the Hospital Anxiety and Depression Scale. Individual data were analysed with weighted mean trend test and two standard deviation band test. Group data were analysed with a randomization test. Results: Visual inspection of the data over the 14-week period showed steady improvement for all of the 10 participants on the majority of variables. A randomization test indicated a statistically significant change in Stroke Self-Efficacy Questionnaire scores and Recovery Locus of Control Scale scores which followed introduction of the intervention. Measures of activity, participation and mood scores did not show a statistically significant change. Conclusion: There is preliminary evidence that the use of an individualized stroke self-management intervention is acceptable and can lead to a change in self-efficacy in this small sample