Effectiveness of a Home-Based Coping Enhancement Program for Stroke Survivors: A Randomized Controlled Trial

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Sunanta Tangnitipong
Nuttamon Vuttanon
Linchong Pothiban
Rojanee Chintanawat


           Stoke is serious and causes disability and dependence, resulting in survivor stress and lack of motivation for self-rehabilitation. Assisting survivors to maintain psychological well-being and adhere to rehabilitation is essential. This randomized control trial investigated the effectiveness of a home-based coping enhancement program on psychological well-being and adherence to rehabilitation in stroke survivors in northern Thailand. The program is based on the Stress Process Model. Sixty-two stroke survivors were randomly assigned to either an experimental (n = 30) or control group (n = 32). The experimental group received the Home-based Coping Enhancement Program in addition to usual care, while the control group received only usual care. Data were collected using the Psychological Well-Being Scale and the Adherence to Rehabilitation Scale, and analyzed using descriptive  statistics, t-test, and two-way repeated measures ANOVA.
           Results indicated that the psychological well-being and adherence to rehabilitation mean scores of the experimental group significantly increased at weeks 6 and 12 after intervention completion. In addition, mean psychological well-being scores in the experimental group were significantly higher than those in the control group at weeks 6 and 12, but not significantly different between groups in the mean adherence to rehabilitation scores. The results revealed that the program could improve psychological well-being among stroke survivors. Further testing of the program is needed before it is incorporated into practice.

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Tangnitipong S, Vuttanon N, Pothiban L, Chintanawat R. Effectiveness of a Home-Based Coping Enhancement Program for Stroke Survivors: A Randomized Controlled Trial. PRIJNR [Internet]. 2022 Sep. 12 [cited 2022 Nov. 27];26(4):585-99. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/259264
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Phipps MS, Cronin CA. Management of acute ischemic stroke. BMJ. 2020;368:l6983. doi:10.1136/bmj.l6983.

Tiamkao S, Ienghong K, Cheung LW, Celebi I, Suzuki T, Apiratwarakul K. Stroke incidence, rate of thrombolytic therapy, mortality in Thailand from 2009 to 2021. Open Access Maced J Med Sci [Internet]. 2022 Jan 16 [cited 2022 Jun 24];10(E):110-5. Available from: https://oamjms.eu/index.php/mjms/article/view/8051

Yingkijsathavorn A, Harnphadungkit K. Quality of life in stroke patients at outpatient rehabilitation clinic, Siriraj Hospital. ASEAN J Rehabil Med. 2020;30(3):123-8.

Wilz G. Predictors of subjective impairment after stroke: influence of depression, gender and severity of stroke. Brain Inj. 2007;21(1):39-45.

Lee PH, Yeh TT, Yen HY, Hsu WL, Chiu VJY, Lee SC. Impacts of stroke and cognitive impairment on activities of daily living in the Taiwan longitudinal study on aging. Sci Rep. 2021;11(1):12199.

Doyle PJ. Measuring health outcomes in stroke survivors. Arch Phys Med Rehabil. 2002; 83(12 Suppl 2): S39-43. doi:10.1053/apmr.2002.36838.

Robison J, Wiles R, Ellis-Hill C, McPherson K, Hyndman D, Ashburn A. Resuming previously valued activities post-stroke: who or what helps? Disabil Rehabil. 2009;31(19):1555-66. doi:10.1080/09638280802639327.

West R, Hill K, Hewison J, Knapp P, House A. Psychological disorders after stroke are an important influence on functional outcomes: a prospective cohort study. Stroke. 2010; 41(8):1723-7. doi:10.1161/strokeaha.110.583351.

Ogwumike O, Badaru U, Adeniyi A. Factors influencing adherence to home-based exercise by stroke survivors in north western Nigeria. Int J Rehabil Res. 2014; 3(1): 8-16.

Duncan PW, Horner RD, Reker DM, Samsa GP, Hoenig H, Hamilton B, et al. Adherence to postacute rehabilitation guidelines is associated with functional recovery in stroke. Stroke. 2002;33(1):167-78. doi:10.1161/hs0102.101014.

Gunnes M, Indredavik B, Langhammer B, Lydersen S, Ihle-Hansen H, Dahl AE, et al. Associations between adherence to the physical activity and exercise program applied in the LAST study and functional recovery after stroke. Arch Phys Med Rehabil. 2019;100(12): 2251-9.

Hubbard IJ, Harris D, Kilkenny MF, Faux SG, Pollack MR, Cadilhac DA. Adherence to clinical guidelines improves patient outcomes in Australian audit of stroke rehabilitation practice. Arch Phys Med Rehabil. 2012;93(6):965-71. doi:10.1016/j.apmr.2012.01.011.

Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;16(2):Cd000011. doi:10.1002/14651858.CD000011.pub3.

Eames S, Hoffmann T, Worrall L, Read S, Wong A. Randomised controlled trial of an education and support package for stroke patients and their carers. BMJ Open. 2013;3(5):e002538. doi:10.1136/bmjopen-2012-002538.

Huppert FA. Psychological well-being: evidence regarding its causes and consequences. Appl Psychol Health Well-Being. 2009;1(2):137-64. doi:10.1111/j.1758-0854.2009.01008.x.

Ryff CD, Keyes CL. The structure of psychological wellbeing revisited. J Pers Soc Psychol. 1995;69:719-27. doi:10.1037/0022-3514.69.4.719.

Wenger GC, Davies R, Shahtahmasebi S. Morale in old age: refining the model. Int J Geriatr Psychiatry. 1995; 10(11):933-43.

Wyller TB, Sveen U, Sødring KM, Pettersen AM, Bautz-Holter E. Subjective well-being one year after stroke. Clin Rehabil. 1997;11(2):139-45. doi:10.1177/026921559701100207.

Clarke P, Marshall V, Black SE, Colantonio A. Well-being after stroke in Canadian seniors: findings from the Canadian study of health and aging. Stroke. 2002;33(4):1016-21. doi:10.1161/01.str.0000013066.24300.f9.

Egan M, Davis CG, Dubouloz CJ, Kessler D, Kubina LA. Participation and well-being poststroke: evidence of reciprocal effects. Arch Phys Med Rehabil. 2014;95(2):262-8. doi:10.1016/j.apmr.2013.08.013.

Brown K, Worrall LE, Davidson B, Howe T. Living successfully with aphasia: a qualitative meta-analysis of the perspectives of individuals with aphasia, family members, and speech-language pathologists. Int J Speech Lang Pathol. 2012;14(2):141-55. doi:10.3109/17549507.2011.632026.

Code C, Herrmann M. The relevance of emotional and psychosocial factors in aphasia to rehabilitation. Neuropsychol Rehabil. 2003;13(1-2):109-32. doi:10.1080/09602010244000291.

Chambers JA, O’Carroll RE, Hamilton B, Whittaker J, Johnston M, Sudlow C, et al. Adherence to medication in stroke survivors: a qualitative comparison of low and high adherers. Br J Health Psychol. 2011;16(3):592-609. doi:10.1348/2044-8287.002000.

Guillaumier A, Spratt NJ, Pollack M, Baker A, Magin P, Turner A, et al. Evaluation of an online intervention for improving stroke survivors’ health-related quality of life: a randomised controlled trial. PLoS Med. 2022;19(4):e1003966.

Bragstad LK, Hjelle EG, Zucknick M, Sveen U, Thommessen B, Bronken BA, et al. The effects of a dialogue-based intervention to promote psychosocial well-being after stroke: a randomized controlled trial. Clin Rehabil. 2020;34(8):1056-71.

Kim GG, Chae DH, Park MS, Yoo SH. Factors influencing 1-year medication adherence of Korean ischemic stroke survivors. Int J Behav Med. 2020;27(2):225-34.doi:10.1007/s12529-020-09854-z.

Schwertfeger JL, Thuente L, Hung P, Larson SL. Postdischarge interventions to enhance coping skills for survivors of stroke and their caregivers: a scoping review protocol. JBI Evid Synth. 2020;18(2):332-40.

Pearlin LI, Mullan JT, Semple SJ, Skaff MM. Caregiving and the stress process: an overview of concepts and their measures. Gerontologist. 1990;30(5):583-94.doi:10.1093/geront/30.5.583.

Schaefer C, Coyne JC, Lazarus RS. The health-related functions of social support. J Behav Med. 1981;4(4):381-406. doi:10.1007/BF00846149.

Bandura A. Self-efficacy. In: Friedman H, editor. Encyclopedia of mental health [Internet]. 3rd ed. San Diego: Academic Press; 1998 [cited 2022 Jun 24], pp. 421-32. Available from: https://archive.org/details/encyclopediaofme0003unse_u6c8

Judge KS, Menne HL, Whitlatch CJ. Stress process model for individuals with dementia. Gerontologist. 2010;50(3):294–302. doi:10.1093/geront/gnp162.

Perna R, Hari L. The role of rehabilitation psychology in stroke care described through case examples. NeuroRehabilitation. 2020;46(2):195-204. doi:10.3233/nre-192970.

Hebert D, Lindsay MP, McIntyre A, Kirton A, Rumney PG, Bagg S, et al. Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015. Int J Stroke. 2016;11(4):459-84. doi:10.1177/1747493016643553.

Jitapunkul S, Lailert C, Worakul P, Srikiatkhachorn A, Ebrahim S. Chula Mental Test: a screening test for elderly people in less developed countries. Int J Geriatr Psychiatry.1996;11(8):715-20.

Khampolsiri T, Pothiban L, Sucamvang K, Panuthai S. A home-based nursing intervention for enhancing quality of life of stroke survivors. Chula Med J. 2006;50(10):707-25.

Robinson-Smith G, Harmer C, Sheeran R, Bellino VE. Couples’ coping after stroke—a pilot intervention study. Rehabil Nurs. 2016;41(4):218-29 doi: 10.1002/rnj.213.

Maujean A, Davis P. The relationship between self-efficacy and well-being in stroke survivors. Int J Phys Med Rehabil 2013;1(7):159. doi:10.4172/2329-9096.1000159.

Sorocco KH, Bratkovich KL, Wingo R, Qureshi SM, Mason PJ. Integrating care coordination home telehealth and home based primary care in rural Oklahoma: a pilot study. Psychol Serv. 2013;10(3):350-2. doi:10.1037/a0032785.

Hoen B, Thelander M, Worsley J. Improvement in psychological well-being of people with aphasia and their families: evaluation of a community-based programme. Aphasiology.1997;11(7):681-91. doi:10.1080/02687039708249415.

Tsuchihashi-Makaya M, Matsuo H, Kakinoki S, Takechi S, Kinugawa S, Tsutsui H, J-HOMECARE Investigators. Home-based disease management program to improve psychological status in patients with heart failure in Japan. Circ J. 2013;77(4):926-33. doi:10.1253/circj.cj-


Chalermwannapong S, Panuthai S, Srisuphan W, Panya P, Ostwald S. Effects of the transitional care program on functional ability and quality of life of stroke survivors. Chiang Mai Univ J Nat Sci. 2010;9(1):49-66.

Hung SH, Wa JYS. Dharma therapy: a Buddhist counselling approach to acknowledging and enhancing perspectives, attitudes and values. 2021. In: Stoyanov D, Fulford B, Stanghellini G, Van Staden W, Wong MTH editors. International perspectives in values-based mental health practice: case studies and commentaries. Cham: Springer International Publishing; 2021. pp. 305-11.

Yao M, Chen J, Jing J, Sheng H, Tan X, Jin J. Defining the rehabilitation adherence curve and adherence phases of stroke patients: an observational study. Patient Prefer Adherence. 2017;11:1435-41. doi:10.2147/PPA.S139854.

Mahmood A, Nayak P, English C, Deshmukh A, Shashikiran U, Manikandan N, Solomon JM. Adherence to home exercises and rehabilitation (ADHERE) after stroke in low-to-middleincome countries: a randomized controlled trial. Top Stroke Rehabil. 2022;29(6):438-48. doi:10.1080/10749357.2021.1940800.