Stroke self-management and the role of self-efficacy.

PURPOSE: This study explored the impact of a 12-week stroke self-management program on occupational performance, the role of self-efficacy on improving occupational performance and the potential barriers and facilitators to self-efficacy as reported by clients and careers. MATERIALS AND METHODS: Participants (n = 40) were recruited to participate in a self-management program after admission to hospital with diagnosis of stroke. A pre-post study was conducted and data were obtained from participants using: the Canadian Occupational Performance Measure, Stroke Self-efficacy Questionnaire, and semi-structured interviews with five participants and two careers. Data analysis was conducted using parametric statistics and thematic analysis. RESULTS: Significant improvements were observed in occupational performance (t = 11.2; p = 0.001) and satisfaction (t = 9.7; p = 0.001). Self-efficacy was shown to be a significant mediator to improvements in occupational performance (F = 7.08; p < 0.01) and satisfaction (F = 6.52; p = 0.02). Three key barriers and facilitators emerged from the thematic analysis: "Support in making the transition home," "Getting back to normal," and "Reflecting on shared experiences." CONCLUSIONS: Engagement in a stroke-specific self-management program can improve client-perceived occupational performance and satisfaction. Self-efficacy was shown to be a mediating variable to occupational performance improvements. Future research should explore further the facilitatory strategies of self-efficacy during stroke self-management programs to maximize rehabilitation outcomes.Implications for rehabilitationMulti-modal self-management programs are recommended as effective for improving client-perceived occupational performance of people who have experienced stroke.Returning to valued occupations, goal setting, shared experiences, and local support are recommended components of a self-management program for stroke survivors.Focusing on enhancing client confidence, competence, and self-efficacy is recommended to achieve occupational performance gains through self-management.Occupational therapy coaching is recommended to guide participants through the self-management processes of goal-setting, shared problem-solving, performance evaluation, and reflection.

Ageing well: Pilot evaluation of a dual-task training program in a rural community.

OBJECTIVE: This pilot trial examined the feasibility and effectiveness of "Ageing Well," a community-based program for improving cognitive skills and mobility of rural older people. DESIGN AND SETTING: The non-randomised, wait-list-controlled pilot trial was conducted at a regional NSW university clinic. PARTICIPANTS: Twenty-three community-dwelling adults aged 60+ who had begun to experience a decline in their physical or cognitive abilities or both. INTERVENTIONS: Dual-tasking activities simultaneously challenged participants' motor and cognitive abilities. Student facilitators encouraged participants to progress through increasing complex functional tasks in a range of contexts, including a café, supermarket and a simulated "home." MAIN OUTCOME MEASURES: The Patient Reported Evaluation of Cognitive State measured the impact of an individual's cognitive state in terms of how much they were "bothered" by problems with their cognition. Functional mobility was measured by the Timed Up-and-Go, a test of static and dynamic balance, and the Six Minute Walk Test. RESULTS: Intervention participants' Patient Reported Evaluation of Cognitive State ratings in relation to impacts on their performance of everyday skills improved substantially, whereas the control group did not change. Intervention participants walked 12% further in the Six Minute Walk Test post-intervention, while the control group distance did not change. Timed Up-and-Go time was reduced by 1 second in the intervention group. CONCLUSIONS: There is a strong interest in this dual-tasking program among older community-dwelling residents in this rural setting. The results of this pilot study support the feasibility and effectiveness of the Ageing Well program. But further trials are warranted.