Health Professional- and Volunteer-partnered Self-management Support (COMBO-KEY) to Promote Self-efficacy and Self-management Behaviors in People with Stroke: A Randomized Controlled Trial

Background Multiple systematic reviews have reported that self-management interventions are associated with positive impacts on self-efficacy and health-related quality of life (HRQoL) of people with stroke. Purpose This article reports the effects of an enhanced stroke self-management program. Methods Eligible adults with stroke were recruited from community-based organizations and a support group for a two-arm, assessor-blinded randomized controlled trial. Participants in the control group received usual care, while those in the intervention group also received the 8-week self-management program, Coaching Ongoing Momentum Building On stroKe rEcovery journeY (COMBO-KEY), consisting of four individual home visits and five follow-up phone calls, delivered by healthcare professionals and trained volunteers. Assessments were conducted at baseline and after the intervention, for outcomes of self-efficacy, satisfaction with the performance of self-management behaviors, HRQoL, and community reintegration, which were analyzed using generalized estimating equations (GEEs). Results 134 Participants were recruited [mean age = 64.1 years, standard deviation (SD) = 12.7]. Over 80% of the participants had a first-ever stroke [mean years after first stroke: 4.2 (SD = 5.1)]. The GEE analysis revealed that the intervention group participants showed significantly greater improvements in self-efficacy, satisfaction with their performance of self-management behaviors, HRQoL, and community reintegration at 8-week follow-up with respect to their baseline levels. Conclusions The COMBO-KEY program showed effective improvements in recovery outcomes of people with stroke. Future research should explore the inclusion of virtual/hybrid sessions, strategies to assess health conditions of people with stroke via online modes, and assessment of goal attainment and actual performance of self-management behaviors. Lay Summary Self-management is the active involvement of a person in managing their overall needs for being able to live well with a chronic condition. Self-management interventions have shown to improve the recovery outcomes of people with stroke. We developed an 8-week long enhanced self-management program "COMBO-KEY" delivered by healthcare professionals and trained volunteers, consisting of individual home visits, follow-up phone calls, peer sharing videos, and enriched resources sharing through a website and a reference guide, aimed at promoting self-efficacy, and self-management behaviors of people with stroke. In this study, 134 adults with stroke were recruited and randomized to either receive the COMBO-KEY program or continue to receiving usual care only. Participants receiving the program showed greater improvements in self-efficacy and self-management behaviors with increased quality of life and reintegrating back to the community after eight weeks compared to the participants receiving usual care. The results highlighted the positive role of a health coaching approach, whereby healthcare professionals, and trained volunteers provide self-management support, to improve the recovery of people with stroke.