Evaluation of an ICF-based patient education programme for stroke patients: A randomized, single-blinded, controlled, multicentre trial of the effects on self-efficacy, life satisfaction and functioning

Sabariego C, Barrera AE, Neubert S, Stier-Jarmer M, Bostan C, Cieza A.
Br J Health Psychol. 2012 Dec 17. doi: 10.1111/bjhp.12013. [Epub ahead of print]

Department of Medical Informatics, Biometry and Epidemiology (IBE), Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University, Munich, Germany.

OBJECTIVE:  There is a current need for interventions that provide information to stroke survivors in a patient-centred, interactive, personalized and flexible manner. To this purpose, a standardized but content-flexible patient education programme based on the International Classification of Functioning, Disability and Health (ICF) was developed. This study evaluated the effect of this programme on perceived self-efficacy.

DESIGN:  Single-blind, randomized, multi-centre controlled trial.

METHODS:  Stroke patients undergoing neurological rehabilitation were enrolled. Perceived self-efficacy was measured with the Liverpool Self-Efficacy Scale. Secondary outcomes were life satisfaction and self-perception of the impact of the stroke on life, measured with the WHOQOL and the Stroke Impact Scale, respectively. Data obtained at baseline, post-intervention and 6-month follow-up were analysed using multi-level models of change.

RESULTS:  Two hundred and thirteen patients received either the ICF-based patient education (n = 110) or an attention-placebo (n = 103) control intervention. Over time, patients’ self-efficacy (p < .01) and participation (p < .01) improved, while emotional functioning (p < .01) deteriorated, although no significant between-group differences were observed. Explorative analyses showed that gender, loci of control, difficulty in accessing health services after discharge and life satisfaction were significant predictors of self-efficacy.

CONCLUSION:  There was no significant benefit of the ICF-based patient education in comparison with an attention-placebo control group. Considering the importance of the programme for the further implementation of the ICF and the need of developing effective health education interventions for stroke, the methodology used was reviewed and an updated version proposed.

STATEMENT OF CONTRIBUTION:   What is already known on this subject? Stroke survivors frequently report dissatisfaction about content, delivery and timing of information provision on several aspects of the disease as well as on available support. Although several interventions targeting information provision have been developed in the past years, an optimal format for such interventions has not been established yet. A recent review of health education interventions for stroke survivors encourages therefore the development of new programs providing information in a patient-centred, interactive, personalised, flexible and repetitive manner. What does this study add? An innovative, standardised but content flexible patient education based on the ICF is evaluated. An implementation possibility of the ICF and of an ICF Core Set in clinical practice is presented. The usefulness of the ICF in providing a valuable framework to structure health education interventions is shown.