Evaluation of an ICF-based patient education programme for stroke patients: A randomized, single-blinded, controlled, multicentre trial of the effects on self-efficacy, life satisfaction and functioning
Article first published online: 17 DEC 2012
© 2012 The British Psychological Society
British Journal of Health Psychology
Volume 18, Issue 4, pages 707–728, November 2013
How to Cite
Sabariego, C., Barrera, A. E., Neubert, S., Stier-Jarmer, M., Bostan, C. and Cieza, A. (2013), Evaluation of an ICF-based patient education programme for stroke patients: A randomized, single-blinded, controlled, multicentre trial of the effects on self-efficacy, life satisfaction and functioning. British Journal of Health Psychology, 18: 707–728. doi: 10.1111/bjhp.12013
- Issue published online: 10 OCT 2013
- Article first published online: 17 DEC 2012
- Manuscript Accepted: 5 NOV 2012
- Manuscript Received: 16 MAR 2012
- German Federal Ministry of Education and Research
- Marie Curie Fellowship
There is a current need for interventions that provide information to stroke survivors in a patient-centred, interactive, personalized and flexible manner. To this purpose, a standardized but content-flexible patient education programme based on the International Classification of Functioning, Disability and Health (ICF) was developed. This study evaluated the effect of this programme on perceived self-efficacy.
Single-blind, randomized, multi-centre controlled trial.
Stroke patients undergoing neurological rehabilitation were enrolled. Perceived self-efficacy was measured with the Liverpool Self-Efficacy Scale. Secondary outcomes were life satisfaction and self-perception of the impact of the stroke on life, measured with the WHOQOL and the Stroke Impact Scale, respectively. Data obtained at baseline, post-intervention and 6-month follow-up were analysed using multi-level models of change.
Two hundred and thirteen patients received either the ICF-based patient education (n = 110) or an attention-placebo (n = 103) control intervention. Over time, patients' self-efficacy (p < .01) and participation (p < .01) improved, while emotional functioning (p < .01) deteriorated, although no significant between-group differences were observed. Explorative analyses showed that gender, loci of control, difficulty in accessing health services after discharge and life satisfaction were significant predictors of self-efficacy.
There was no significant benefit of the ICF-based patient education in comparison with an attention-placebo control group. Considering the importance of the programme for the further implementation of the ICF and the need of developing effective health education interventions for stroke, the methodology used was reviewed and an updated version proposed.
Statement of contribution
What is already known on this subject? Stroke survivors frequently report dissatisfaction about content, delivery and timing of information provision on several aspects of the disease as well as on available support. Although several interventions targeting information provision have been developed in the past years, an optimal format for such interventions has not been established yet. A recent review of health education interventions for stroke survivors encourages therefore the development of new programmes providing information in a patient-centred, interactive, personalized, flexible and repetitive manner.
What does this study add? An innovative, standardized but content flexible patient education based on the ICF is evaluated. An implementation possibility of the ICF and of an ICF Core Set in clinical practice is presented. The usefulness of the ICF in providing a valuable framework to structure health education interventions is shown.