Implementing a Participation-Based Self-Management Program for People Who Have Experienced Stroke into the Outpatient Day Rehabilitation Setting

Background: People who experience stroke face barriers to participation and are not fully integrated into their homes, communities and work. Current rehabilitation practice is dominated by impairment reduction and decreasing... [ view full abstract ]

Background:
People who experience stroke face barriers to participation and are not fully integrated into their homes, communities and work. Current rehabilitation practice is dominated by impairment reduction and decreasing burden of care, often leaving little time for interventions that enhance performance of meaningful occupations and long-term participation in the community.
Theoretical underpinning:
The Person Environment Occupation Performance (PEOP) model was used as the theoretical framework for the self-management intervention program.
Intervention:
A participatory action research approach was used to include consumers who have experienced stroke into the development, implementation and evaluation of the program. Participants attended 6, 1-hour OT group sessions, 2 times per week. Assessments occurred prior to and immediately following the program and included the Canadian Occupational Performance Measure (COPM), the Executive Function Performance Test (EFPT), the Community Participation Index (CPI) and the Participation Self-Efficacy Scale (PS-SES).
Evaluation of outcome:
Four participants completed the OT self-management program. Participants reported increases in satisfaction and perceived occupational performance on the COPM. Total EFPT scores improved for 3 of 4 subjects. Three participants reported increases in self-efficacy per the PS-SES. All participants reported an increase in community participation and sense of enfranchisement per the CPI.
Application to practice:
Implementation of a stroke specific self-management program into occupational therapy day rehabilitation services was feasible and reimbursable. Self-management interventions focused on participation in the home, community and in productive roles and co-facilitated by a peer mentor are feasible in an outpatient day rehabilitation setting and enhance meaningful participation outcomes for stroke survivors.