Self-efficacy and self-management after stroke: a systematic review

PURPOSE: The purpose of this review is to examine (1) the influence of self-efficacy on rehabilitation outcomes post-stroke, and (2) the evidence to support self-management interventions based on self-efficacy principals for stroke survivors. METHOD: Medline, Embase, Psychlit, Web of Science, AMED and Cochrane Databases for systematic reviews databases were searched for relevant articles in English between 2000 and ending in July 2009. Articles included (1) primary research testing relationships between self-efficacy and rehabilitation outcomes including the measuring impairment and activity or participation in a stroke population, and (2) research testing efficacy and effectiveness of self-management interventions designed specifically for a stoke population in which the principle theoretical framework is self-efficacy or a similar control cognition. Methodological quality appraisal and data extraction was carried out by two reviewers. RESULTS: Of the 104 articles that were identified by the search, 22 met the criteria to be included in the review. There is evidence that self-efficacy is an important variable associated with various outcomes post-stroke. These outcomes include quality of life or perceived health status, depression, ADL and, to a certain extent, physical functioning. Further empirical evidence is needed to extend these findings, and to determine whether self-efficacy has additional predictive value over and beyond the objective measures of impairment. There is also emerging evidence of benefits to be gained from programmes that target self-management based on self-efficacy principles; however, the optimal format of delivering these interventions for stroke survivors is not clear. CONCLUSIONS: There is a need for researchers, to work together with other stakeholders to develop and test interventions that can support self-management skills and confidence to make continued progress after stroke. This could help to reduce some of the negative consequences of stroke such as reduced quality of life and social isolation.