Do self-management interventions improve self-efficacy and health-related quality of life after stroke? A systematic review

Introduction: Self-management interventions are recommended after stroke in many international guidelines to improve health-related quality of life (HRQoL). Self-efficacy, a person’s confidence in their abilities, is widely considered to underpin individuals’ abilities to self-manage their health. 

Aims: To synthesize evidence on the effectiveness of self-management programs for improving self-efficacy or HRQoL in stroke survivors. 

Summary of Review: The protocol was registered with the International Prospective Register of Systematic Reviews (CRD42023440168). We searched databases including Medline, Emcare, Scopus, Cochrane Library, CINAHL, and trial registries from inception to 13/12/2024. Only randomized controlled trials (RCTs) comparing the effect of a self-management intervention to no/another intervention for survivors of stroke on self-efficacy or HRQoL were included. Risk of bias was assessed using the Cochrane Collaboration criteria. Meta-analyses for self-efficacy and HRQoL were performed using random effect model. From 13,608 abstracts screened, 44 randomized controlled trials involving 5931 participants were included. Median time post-stroke of recruited participants ranged from 14 days to 3 years. Time required to deliver the interventions ranged from 45 min to 72 h. Self-management interventions in all included trials had multiple components, predominantly education (N = 40, 91%) and goal setting (N = 39, 89%). Interventions were delivered to individual survivors of stroke (N = 18, 41%), groups of survivors (N = 15, 34%), both individual and group delivery to survivors (N = 5, 11%) and individually to survivor-carer dyads (N = 6, 14%). Interventions were delivered entirely face-to-face (N = 28, 64%), entirely by phone or video-conferencing (N = 7, 16%) or a combination of these delivery modes (N = 9, 20%). There was low certainty evidence that self-management programs compared to no intervention did not significantly improve self-efficacy on pooled effect sizes (SMD 0.08, 95%CI -0.02 to 0.18). There was moderate certainty evidence that self-management programs had a marginal significant effect on HRQoL (SMD 0.07, 95% CI 0.01 to 0.13). Limitations to the review include marked variation between included studies in the interventions delivered, and outcome measures used, targeted behaviors and time since stroke. 

Conclusion: Self-management programs varied markedly in content and dose. There is low-certainty evidence that currently designed self-management programs do not significantly improve self-efficacy. There is moderate certainty evidence that self-management programs have a small effect on HRQoL after stroke.