The effect of self-management programs on post-stroke social participation: A systematic review and meta-analysis

The aim of this study was to identify the effectiveness of self-management programs on the improvement of social participation among stroke survivors. Data Sources: Cochrane Library, PubMed, Web of Science database, EMBASE, Medline, CINAHL plus, and APA PsycArticles were searched from their inception to December 20, 2021.

We considered randomized controlled trials and non-randomized controlled trials without language limits. Two reviewers independently screened the literature, evaluated risk of bias using the Cochrane's risk of bias tool, scored the methodological quality using criteria of the Australian Evidence-based Health Care Center, and extracted the data. The outcome was social participation. RevMan 5.3 was used, and intergroup differences were determined by calculating standardized mean difference (SMD) and 95% confidence intervals (CIs).

Of 1894 initial studies, totally 15 studies met the eligible criteria, consisting of six randomized controlled trials and nine non-randomized controlled trials. Four randomized controlled trials showed high methodological quality and two demonstrated medium quality. The randomized controlled trials involved a total of 430 stroke survivors and were published between 2007 and 2020. The meta-analysis from five randomized controlled trials demonstrates that the overall effect of self-management programs on social participation was not statistically significant (95% CI, -0.23 to 0.40; p = 0.61). Most of the non-randomized controlled trials were pre-/post-test design with an average sample size of 15.4. The effect of self-management program on social participation in most non-randomized controlled trials was insignificant as well.

The self-management programs seem not to be superior to usual care for the improvement on social participation in stroke survivors based on current evidence. Further well-designed investigation considering social participation as the primary outcome is still warranted.