THE EFFECTIVENESS OF SELF-MANAGEMENT INTERVENTIONS WITH ACTION-TAKING COMPONENTS ON THE IMPROVEMENT OF HEALTH-RELATED OUTCOMES OF ADULT STROKE SURVIVORS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Many stroke survivors suffer from permanent disabilities. Self-management interventions involving action-taking as an essential component could maximise their health related outcomes through improving self-efficacy. However, no review has specifically explored these interventions’ effectiveness for adult stroke survivors. Objectives: To synthesise the evidence of the effectiveness of self-management interventions with action-taking components on self-efficacy (primary outcome), health-related quality of life, basic and instrumental activities of daily living, and depression on adult stroke survivors. Design: Systematic review and meta-analysis. Methods: Nine electronic databases (PubMed, Embase, Scopus, CENTRAL, Web of Science, CINAHL, PsycINFO, ProQuest Dissertations and Theses Global, and ClinicalTrials.gov) were searched for relevant studies, including grey literature and ongoing studies. Randomised controlled trials targeting adult stroke survivors comparing health-related outcomes of patients receiving self-management interventions with action-taking components to usual care, placebo, or no-treatment were included. Screening, data extraction and methodological quality assessment were conducted by two reviewers. Meta-analyses were performed for all measured outcomes. Findings that could not be pooled statistically were narratively summarised. Overall quality of evidence was assessed using the GRADE tool. Results: Seventeen studies were included. Meta-analyses showed some evidence of the intervention on improving self-efficacy (SMD=0.29, 95% CI [0.07 to 0.52], p=0.010, I2=47%) and basic activities of daily living (SMD=0.31, 95% CI [0.16 to 0.46], p<0.001, I2=0%), but not for the other outcomes. Findings for all outcomes were rated as low-quality evidence, except for depression (very low). Conclusion & Implications: This review demonstrated significant effects of self-management interventions with action-taking components on improving self-efficacy and basic activities of daily living. Healthcare professionals could weigh the importance of taking-action components when designing a self-management programme. Future research should investigate which core self-management skill, or combination of them, is most effective in improving short-term and long-term outcomes.