Effect of self-management of stroke patients on rehabilitation based on patient-reported outcome

This study aimed to investigate the effect of self-management behavior on the rehabilitation of stroke patients to lay a theoretical basis for using patient-reported outcome (PRO) for rehabilitation evaluation of stroke patients.

396 patients hospitalized in the Department of Neurology of 4 tertiary general hospitals in Datong from August 1st 2018 to March 31st 2020 were included in accordance with the inclusion and exclusion criteria. The included patients were randomly assigned into a self-management intervention group and a control group. Only the control group received the clinical pathway intervention of stroke rehabilitation. The stroke patients in the intervention group received the self-management intervention in addition to the clinical pathway intervention of stroke rehabilitation. The self-management status and rehabilitation results of the patients were evaluated in 24 h and 3 months after the patients were enrolled, respectively. Statistical description and analysis were conducted using SPSS20.0 statistical software. The general data of the patients were expressed by percentage. The data regarding patients' self-management and rehabilitation results were statistically described by percentage, mean and standard deviation. The comparison between groups was drawn through t-test and analysis of variance. Bonferroni method was used for multiple comparison correction. The correlation between rehabilitation results and patients' basic conditions and self-management was investigated through Pearson correlation analysis. The main factors for self-management behaviors were studied through multiple stepwise regression analyses.

The total scores of self-management behaviors of the investigated subjects achieved statistical significance in different ages, occupations, educational levels, income levels, exercise intervention, past medical history, BMI, as well as marital status (P < 0.01). In this study, there was no statistical difference in different genders and medical insurance status (P > 0.05). The total scores of self-management behaviors and the scores of the respective dimension were positively correlated with the health education, exercise intervention, functional training, psychological intervention, food intake, living habits, and functional training of stroke patients at the recovery stage. Educational level and marital status were positively correlated with the rehabilitation results of patients. The PRO questionnaire for the stroke scored higher in married patients and highly educated patients, and there were statistically significant differences (P < 0.01). Family history was negatively correlated with the rehabilitation results of patients. Exercise intervention and functional training were positively correlated with the rehabilitation results of patients.

Education level, health education, food intake, exercise and rehabilitation training, sleep, and psychological intervention were the main factors for self-management behavior in stroke patients at the recovery stage. Self-management interventions can effectively increase the health education level of stroke patients, strengthen their self-confidence in disease self-management, facilitate the establishment of effective self-management behavior of patients, and improve their quality of life and subjective well-being. Stroke PRO scale can be used to evaluate the clinical intervention effect of self-management on stroke patients in multiple dimensions, especially evaluating the improvement of subjective mental and psychological state of patients, thus revealing the intervention effect of self-management on stroke patients comprehensively.