Date Presented 04/05/19
The purpose of the study was to develop and evaluate the feasibility of a culturally tailored, community-based life management intervention to improve quality of life and mitigate stroke risk factors in 10 individuals after experiencing a stroke. The intervention was feasible in this sample with positive outcomes for participant retention and attendance; engagement in meaningful activities; stroke-related quality of life; reintegration to normal living; and healthy behavior changes.
Primary Author and Speaker: Valerie Hill
Additional Authors and Speakers: Valerie Miller
Contributing Authors: Amytis Towfighi
PURPOSE: Individuals with stroke often experience physical, cognitive, and social limitations and have a high risk of recurrent stroke, causing compounding health issues and a lack of meaningful activity engagement. This causes decreased quality of life and increased risk of recurrent stroke. Occupational therapists are well suited to administer culturally tailored, life management interventions that mitigate secondary stroke risk through meaningful activity engagement.
To test the feasibility of a life management intervention for stroke survivors from racially/ethnically diverse, underrepresented populations by inculcating sustainable health-promoting behaviors, improving stroke- related quality of life, and mitigating recurrent stroke risk factors.
DESIGN: Feasibility study: Participants were recruited from stroke support groups at a large rehabilitation center and a certified stroke hospital. Inclusion criteria: 1) aged 50-75 years; 2) stroke or TIA ≥ six months prior to study enrollment; 3) from a disadvantaged, minority background; 3) rehabilitation center outpatient; and 4) English- or Spanish-speaking.
METHOD: Outcomes: Participant retention and adherence; engagement in meaningful activities; stroke-related quality of life; reintegration to normal living; and healthy behavior changes (such as diet, and decreased smoking). Frequencies and percentages were used for participant retention and adherence. Averages were calculated for each of the outcome measures pre- and post- testing. T-tests were used to determine statistically significant changes from pre-post for all outcome measure scores. Intervention: Six-month culturally tailored, life management intervention in which participants met with an occupational therapist weekly in one-on-one or group sessions. Intervention focused on meaningful activity engagement and reducing secondary stroke risk factors.
RESULTS: Ten individuals were enrolled in the study with a retention of 90% (one participant withdrew before the intervention began) and attendance rate was ∼95% (n=9). There were 8 male participants ranging from ages 56-77 years old having had their stroke 2-15 years prior. Participants average monthly income was $1,343, were mostly unemployed and on disability (8), had attended some college (7) or didn’t finish high school (3), and had multiple concomitant health issues (high blood pressure, diabetes, obesity, former drug use). On average, participants had improvements in quality of life domains, specifically in engagement in meaningful activities*, returning to normal living, stroke-related quality of life (communication*, hand function*, general activity performance, and overall recovery from stroke*); and health behavior changes in diet (reduced fat intake and greater fruit and vegetable intake), and the one participant who was a smoker reduced the number of cigarettes she smoked per day. (Statistically significant findings are identified with an asterisk).
CONCLUSION: The six-month culturally tailored, life management intervention was feasible for this small sample of ethnically/racially diverse individuals with stroke, particularly for meaningful activity engagement, and stroke-related quality of life related to communication, hand function, and overall stroke recovery. The positive trends in re-integration to normal living and healthy behavior changes are promising results for functional independence, quality of life, and reducing secondary stroke risk factors.
IMPACT STATEMENT: This study is important to practice and policy because it supports the feasibility of a life management intervention enabling individuals with stroke to develop behaviors that lessen stroke risk and improve quality of life.
References
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Hill V. A., Vickrey B.G., Cheng E.M., Valle N.P., Ayala-Rivera M., Moreno L., Munoz C., Dombish H., Charlton A., Wang D., Ochoa D., Heymann R., Clark F., Towfighi A. (2017) A Pilot Randomized Controlled Trial of a Lifestyle Intervention for Stroke Survivors: Design of Healthy Eating And Lifestyle after Stroke (HEALS). Journal of Stroke and Cerebrovascular Diseases. doi:10.1016/j.jstrokecerebrovasdis.2017.06.058
Hill, V. & Towfighi, A. (2017) Modifiable Risk Factors for Stroke and Strategies for Stroke Prevention. Seminals in Neurology; 37:237-258. doi: 10.1055/s-0037-1603685
