Effectiveness of self-management interventions during the peri-hospitalization period in patients with stroke: A systematic review and meta-analysis

Abstract

Objective To synthesize the evidence of the effectiveness of self-management interventions during the peri-hospitalization period. Data sources Three databases (i.e. PubMed, Web of Science, and Scopus) were systematically searched. Review methods Full-text randomized controlled studies that assessed the effects of self-management interventions initiated during the peri-hospitalization period in patients with stroke were included. Two independent reviewers performed data extraction. A third reviewer was available for discrepancies. The methodological quality was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2). Data were pooled and a meta-analysis was performed. Results Eight studies comprising 1030 participants were included. The self-management interventions showed considerable heterogeneity in their protocols, although most of them included an individualized plan based on the patient's needs. The meta-analysis was performed with data from the self-efficacy domains. The pooled results showed a trend towards the self-management intervention on quality of life (1.07, 95% confidence interval [CI] 0.52 to 1.63; P = 0.0002) but neither in dependence (0.80, 95% CI −0.14 to 1.74; P = 0.10) nor in self-efficacy (0.77, 95% CI −0.44 to 1.98; P = 0.21). Conclusion Most of the studies reviewed suggest that self-management interventions had an impact on dependency, quality of life and self-efficacy when compared with usual care, written materials about stroke, or post-discharge rehabilitation recommended by a physician. However, the evidence in this review neither supports nor refutes self-management interventions used in addition to usual care, or other interventions, to improve dependency, quality of life and/or self-efficacy in patients’ post-stroke.