Presenting Author:

Danbi Lee, Ph.D.

Principal Investigator:

Danbi Lee, Ph.D.

Department:

IPHAM

Keywords:

stroke, self-management, social participation, occupational therapy, rehabilitation

Location:

Third Floor, Feinberg Pavilion, Northwestern Memorial Hospital

PH6 - Public Health & Social Sciences

Examining a novel stroke self-management intervention in outpatient rehabilitation

Background: People with stroke often find discharge from rehabilitation distressing because they do not feel prepared to live in the community and participate in life roles as they want. A self-management approach can facilitate improvement in confidence and ability to problem-solve and manage barriers to community 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 an outpatient day rehabilitation setting with adults with stroke. Intervention: The IPASS-R program was designed to support long term management of community living and participation after having a stroke. The program is a 6 session group-based intervention led by a trained occupational therapist and lay person with stroke. The program uses an efficacy building approach through repeated problem-solving and action planning processes, social learning and role modeling, and situated learning opportunities (i.e., community outings). Methods: A mixed-method nonrandomized quasi-experimental design was utilized. Two day rehabilitation centers were selected and assigned as control and intervention sites. Participants were included if they were 45 years or older and had a mild to moderate stroke without severe aphasia or cognitive impairments. Pre- and post-test data were collected. Primary outcome measures were the Reintegration to Normal Living Index, Stroke Impact Scale, and Participation Strategies Self-Efficacy Scale. Qualitative feedback was collected post treatment. Findings: A total of 17 participants with stroke (intervention n=9; control n=8) were enrolled. Analysis using non-parametric effect sizes (d) revealed moderate to large treatment effects on community integration, perceived recovery, strength, and communication outcomes. Overall, there was a trend of improvement in the intervention group compared to the control group. An on-site coordinator, transportation, and community space were needed. Attendance rate was 96%. Retention rate for the intervention group was 75% and control group was 100%. Conclusion: The result shows that IPASS-R is feasible to integrate into the day rehabilitation setting and has a positive impact on perceived participation, recovery, and community reintegration for the intervention group compared to the control group. Future study is needed to investigate the IPASS-DR with a larger sample size and more rigorous study design.