Efficacy of the Improving Participation after Stroke Self-Management-Rehabilitation (IPASS-R) program in sub-acute stroke

Project Summary/Abstract The long-term goal of this research is to improve self-efficacy, activity performance, and health in individuals with stroke. Current stroke rehabilitation research and practice must be addressed to shift the focus of the field from an over-emphasis on impairment reduction to management of stroke as a chronic disease.

The overall hypothesis of this proposal is that a clinically feasible, self-management-based intervention, the Improving Participation after Stroke Self-Management Rehabilitation (IPASS-R) program, will produce a significant improvement on measures of self-efficacy, activity performance, quality of life, and community

engagement outcomes as compared to a general health-focused self-management program, the Chronic Disease Self-Management Program (CDSMP). All assessment and intervention procedures will be conducted virtually via videoconferencing. The specific aims of this project in the subacute stroke population are to: (1)

evaluate the efficacy of IPASS-R to improve self-efficacy within home, community, and work activity performance; (2) evaluate the efficacy of IPASS-R to improve activity performance and quality of life; and (3) explore the effect of IPASS-R on objective measures of in-home activity patterns and community engagement.

Participants with subacute stroke living in the community will be recruited through local hospitals at two sites (n = 100). Those individuals who meet eligibility criteria will be randomized to either an IPASS-R group or to a CDSMP group. Both groups will receive six, 90-minute group sessions of self-management education.

Treatment outcomes will be assessed at baseline, post-intervention, and at six-months post-intervention. Treatment efficacy outcomes will be analyzed with an intent-to-treat model with an analysis of covariance (ANCOVA). Potential covariates will include age, stroke severity, degree of cognitive impairment, and degree

of motor impairment. Independent samples t-test and chi-square test will be used to ensure successful randomization and balance between groups. Group differences at baseline that are statistically significant will also be considered as covariates in the analysis. Post-hoc tests will be employed as appropriate. Significance

levels, effect sizes, and confidence intervals will be reported. Completion of this study is likely to result in an efficacious, clinically feasible intervention to improve self-efficacy, activity performance, and participation in individuals with stroke that can be feasibly implemented into current systems of care. The proposed study and

anticipated outcomes are consistent with the research priorities of the National Center for Medical Rehabilitation Research (NCMRR), which include which include rehabilitation interventions focused on chronic symptom management with real-world, participatory outcomes and objective markers of functional progress.