RESEARCH QUESTION: Will stroke survivors improve self-reported health behaviors and increase physical performance following participation in a 12-wk stroke-specific self-management program?

RATIONALE: The Health H.E.A.R.T.s program (health, education, and recovering together) was developed to provide secondary stroke prevention education to individuals who have survived a previous stroke. The American Heart Association states that >795,000 people in the United States have a stroke each year. Nearly one in four of those are recurrent. Recurrent strokes often yield a higher rate of mortality and disability. Survivors may experience modest impairments, including significant changes in physical and psychological abilities, loss of roles, increased burden of care and decreased quality of life.

Self-management education encourages participants to take an active role in the day-to-day management of their chronic conditions. The goal of self-management programming is for persons to be able to manage and maintain wellness while living with their condition. This goal is met by addressing five self-management skills: problem solving, decision making, finding and utilizing resources, developing partnerships with health care providers, and taking action. Self-management education programs have been studied and found to be successful with chronic conditions such as chronic pain, arthritis, and diabetes.

The aim of this pilot study was to apply these concepts in a group of stroke survivors to assess reduction of risk factors and adoption of behaviors to improve health responsibility and participation in physical activity.

DESIGN: This study used a prospective cohort design. Participants attended a 12-wk interdisciplinary stroke-specific self-management group program that addressed stroke risk factors and strategies to adopt healthy behaviors including coping, nutrition, and modified exercise program.

PARTICIPANTS: Participants were recruited through referrals from the outpatient rehabilitation hospital at the location of the principal investigator. Inclusion criteria included: age 21 or above, history of mild to moderate stroke, at or near discharge from outpatient rehabilitation services, and able to speak and understand English or Spanish and consent to participate. Potential participants were excluded if they were deemed to have significant cognitive deficits.

METHOD: The Health Responsibility subset of the Health Promoting Lifestyle Profile II (HPLP II) was used to measure self-reported frequency of engagement in certain health behaviors. The Jamar dynamometer and the 6-min walk test were used to measure grip strength and functional cardiovascular endurance, respectively. All measures were given at the start of the program and at the end of the 12 wk. Data were analyzed for participants who completed at least 75% of the program.

ANALYSIS: Descriptive statistics were used to describe the study sample. Paired t tests were used to determine pre- and posttest differences in measurements on the HPLP II, dynamometer, and 6-min walk test. SPSS Version 19 was used for all data analysis.

RESULTS: Twenty participants were enrolled in the 12-wk program. Sixteen participants completed at least 75% of the program. Preliminary results show increases on all three pre- and posttest measures.

DISCUSSION: Participants improved in self-reported behaviors in managing their health conditions and reported satisfaction and overall continued changes in diet and exercise.

IMPACT STATEMENT: The Healthy H.E.A.R.T.s program promotes healthy lifestyle habits to minimize risk of secondary stroke. This program provides an innovative approach to delivering care in a stroke population to meet ongoing reimbursement changes and increase therapist efficiency.