2. Intervention Description
2.1. Item 1. Brief Name
2.2. Item 2. Why: Description of the Rational and Theory Essential to the Intervention
- Identification of the evidence base for the LAY intervention.
- Set-up of the LAY intervention in terms of contents, duration, and delivery.
- Test the relevance of contents and the feasibility of sessions and the fine-tuning review process.
2.3. Item 3. What: Description of Materials
2.4. Item 4. What: Procedures Followed
- Week 1: group session 0.
- Week 2: individual session 1 and group session 1.
- Week 3: group session 2.
- Week 4: group session 3.
- Week 5: individual session 2 and group session 4.
- Week 6: group session 5.
2.5. Item 5. Providers
2.6. Item 6. LAY Intervention Delivery
2.6.1. Group Sessions
2.6.2. One-to-One Sessions
2.7. Item 7. Where: Type of Location
2.8. Item 8. When and How Much
2.9. Item 9. Tailoring
- During the first few weeks after the event, individuals need time to understand what has happened, so the program focuses on the development of coping and adaptation strategies from the very first rehabilitation phase.
- Furthermore, in the post-acute phase, stroke survivors may experience reduced attention span, memory capacities, and communication deficits; for these reasons, the CDSMP contents were simplified and individual sessions were introduced.
- Both the individual sessions and the action plan guarantee the tailoring of the intervention to each patient because the individual sessions targeted at accidental fall prevention explored the patient’s specific performance and context, and because the action plan trained the individuals to identify their own significant goals and to solve their specific problems.
2.10. Item 10. Modifications during the Course of the Study
2.11. Item 11. How Well (Planned)
2.12. Item 12. How Well (Actual)
3.1. Limitations of the Intervention
3.2. Strengths of the Intervention
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Study||Sample Size||Experimental Self-Management Program||Duration of the Program||Timing of the Program Initiation||Program Leader||Setting of Delivery||Theoretical Basis/Model|
|Allen, 2002 ||96||Individualized intervention, including an initial home biopsychosocial assessment and education visit, and a team-based development and implementation of an individualized treatment plan focused on health promotion and psychosocial|
|3 months||Within 1 month post-discharge from stroke unit||Advanced practice nurse care manager||Participants’ homes||Wagner’s chronic care model|
|Allen, 2009 ||380||As for Allen 2002 .|
The average time spent on intervention was 8.5 h/patient and included a minimum of 2 home visits and periodic phone calls
|6 months||Within 2 months from post-stroke unit admission||Advanced practice nurse care manager||Participants’ homes||Wagner’s chronic care model|
|Cadilhac, 2011 ||143||Weekly 2½-hour group sessions including targeted stroke-specific information and strategies to ensure retention of learning and skills||8 weeks||At least 3 months post stroke||National Stroke Foundation’s Stroke Educator and a trained peer facilitator||Community||Stanford CDSMP|
|Damush, 2011 ||63||6 biweekly 20-min telephone calls guided by a standardized manual and targeted to building self-efficacy using goal setting and behavioral contracting||3 months of intervention + 3 months of telephone monitoring and reinforcement||Within 1 month from stroke||Trained nurse, physician, and social scientist||Telephone calls||Stanford CDSMP|
|Frank, 2000 ||41||Two one-to-one sessions plus weekly telephone calls guided by a workbook including information, coping resources, relaxation techniques, problem-solving skills, and rehearsing planning||1 month||Within 24 months from stroke||Researcher||Participants’ homes||Control cognitions (including self-efficacy)|
|Harwood, 2011 ||139||80-min one-to-one session guided by a specific workbook and designed to engage the patient and his/her family in the process of recovery and self-directed rehabilitation, plus/or 80-min inspirational dvd about stroke, stroke recovery, and promoting self-directed rehabilitation strategies||80 min||6 to 12 weeks post-stroke||Trained research assistants||Community||Self-efficacy principles|
|Johnston, 2007 ||203||3 one-to-one and 2 telephone sessions guided by a workbook. The workbook provided information about stroke and recovery and included activities|
designed to allow the patient to attain the coping skills to encourage self-management. An audio relaxation cassette tape was provided.
|5 weeks||Within 2 weeks from hospital discharge||Researcher||Participants’ homes||Control cognitions|
|Kendall, 2007 ||100||2-h group sessions including both generic chronic condition and stroke-specific self-management education regarding health and well-being, group interaction and support, problem solving||7 weeks||3 months post-stroke||Trained healthcare professionals||Community||Stanford CDSMP|
|Marsden, 2010 ||26||Weekly 2½-hour group session including physical activity and education, always addressing nutritional counseling||7 weeks||At least 1 month post-discharge from all stroke therapy programs||Multidisciplinary stroke team members||Local community public hospital||Not described|
|McKenna, 2013 ||25||Weekly one-to-one sessions up to one hour/week, with the support of a stroke workbook, to promote specific self-management behaviors, such as enabling patients to set personalized goals, plan feasible actions, record progress, and problem solving.||6 weeks||Within 4 weeks of commencing rehabilitation in the community||Trained members of the community stroke team||Community||Self-efficacy principles|
|Session n°||Structure||Specific Topics||Specific Activities|
|1||Common Structure||Using mind to manage symptoms|
Difficult emotions management
|2||Good communication (help request)|
Enjoying a good quality sleep
Pain and fatigue management
Falls prevention and balance exercises
Before the 1st group session
Before the 4th group session
|Main Sources of Self-Efficacy||Technique/Instrument||In LAY Intervention|
|Mastery experiences||Breaking the task into smaller, achievable components to achieve a positive result in a task or skill||Weekly realistic action plan|
|Vicarious experiences||Observe someone perceived to be a peer (model) successfully performing a task, i.e., learning from others’ experiences of the post-stroke recovery period||Interactive group sessions|
|Verbal persuasion||Persuasion and verification from significant individuals (stroke professional or key family member) to increase an individual’s belief about his/her personal level of skill||Successful action plans shared during group sessions|
Positive feedback from health professionals
|Physiological feedback||Interpretation of individual’s physical sensations and emotions and feelings as positive||Training in positive thinking|
Training in relaxation techniques
|Self-management abilities||Technique/Instrument||In LAY Intervention|
|Problem solving||Information on stroke, risk factors, care pathway, and consequences of stroke||Repetition of problem-solving technique in individual and group sessions|
|Decision making||Repetition of how to make decisions||Goal setting and decision making in individual and group sessions|
|Appropriate resource utilization||Giving information to facilitate knowledge and access to community resources||Oral information in a group session and written information in patients Manual|
|Partnership with healthcare professionals||Training in how to ask for help||Training patients’ ability to communicate and collaborate in a group session|
|Taking necessary actions||Action plan as a good instrument to focus on achievable goals||Training in action planning every week for 6 weeks|
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