What can make a difference? What can help to adapt better at home?
For patients with chronic conditions, coping and self-efficacy have been found to be a predictor for mood, quality of life and functional independence.
Intensive rehab intervention and a high amount of therapy are proven to be effective in the acute and post-acute phases of stroke. Long term intervention at home and progress after a stroke, on the other hand, is a complex topic.
Self-efficacy and self-management have shown to be beneficial for stroke survivors, as well as involving family members. Building up a support system can also be a coping strategy. (1,2)
The keyword “self-efficacy”
Self-efficacy means: to have confidence in yourself, to believe in your ability to perform a specific task. Studies show that patients with high self-efficacy function better in daily life than others with low self-efficacy.
Self-efficacy can be developed and guided through different experiences. Successfully performing a task, observing others (modeling), encouragement by professionals or family and being aware of the physiological state can be a source of influence. (3)
Stroke survivors often report a feeling of loss of independence and helplessness.
Not being able to handle simple activities of daily life and losing one’s voice is what often happens during the first step of rehabilitation. A feeling of boredom, frustration and a desire for more autonomy was reported by patients when evaluating their rehabilitation experience. (4,5)
Earning back a sense of self-efficacy and enhancing patient confidence through self-management has shown to be beneficial. Gaining confidence and competence can achieve more occupational performance post-stroke. Involving stroke survivors and their caregivers into the rehabilitation process and giving them tools for self-management can improve outcomes and satisfaction. (2,6,7)
Therapy doesn’t stop outside the gym
Studies have shown that more therapy time can improve activity after stroke. The amount that therapy time has to be increased although, is an additional 240%. Often this amount of therapy can not be provided or is not affordable.
A suggested method of providing more therapy or exercise time is to involve caregivers, family members and the patient itself. An individual exercise program that is evaluated can positively influence the outcome after stroke.
Providing and encouraging patients with independent practice outside of supervised therapy time can increase the therapy dose. (8,9)
Home-based rehabilitation after a stroke could be another method and has shown to be beneficial. Structured and individualized exercise can extend the therapy time. Although acceptance is positive, important information can get lost and reinforcement is necessary. Often a simple task sheet or a video can help to provide a clear structure. Increasing the enjoyment of the exercise can also assist with adherence. Video gaming and virtual reality can be of help in achieving that.
The positive attitude towards mobile-based home exercise programs by stroke survivors show a high potential for home-based rehabilitation. (10,11)
Encouragement and support from the family are not only important to foster self-efficacy but also to be more efficient with home-based rehabilitation. Self-management can be challenging, especially in the beginning, but involving family members has shown to be beneficial for stroke survivors. (2,3)
In order to reduce boredom and foster more autonomy in and after rehabilitation solutions are needed. Technology has the potential to extend therapy time. Providing objective feedback and improving motor performance through a higher amount of repetition, rehabilitation technology can be used in addition to conventional therapy. As a home-based stroke rehabilitation, mobile solutions can be effective and add additional therapy time for patients. The readiness of stroke patients and their caregivers to try different approaches is a beneficial factor. (4,10,12)
Tools for self-efficacy
Less than 65 % of stroke survivors reported neglecting to do at least part of their home-exercise programs. Although knowing that exercise programs are important and a potential motivation, sticking with the home-exercise programs is sometimes a struggle. (13)
Getting exercise programs and instructions and actually doing them are two different things.
Music lessons, weekly reports, and visits to a doctor have one thing in common: accountability. Accountability is what encourages people to do expected activities or follow expected behavior. It can be used in therapy to enhance motivation. Although accountability is a social phenomenon, it doesn’t necessarily require direct human contact.
Weekly reports or mobile check-ups can encourage motivation and beneficial behavior. Autonomous accountability should be the goal of a therapist-patient relationship. Accountability is one tool to improve self-efficacy and self-management and can help patients stick to their treatment plans. (4,14)
Intrinsic motivation has been found to be a predictor to enhance learning, performance, and wellbeing. Personal interest is known as an intrinsic factor in the same way that rewarding is a factor of extrinsic motivation. Combining interesting and engaging activities with praise while also rewarding the patient during exercise, can be beneficial for perseverance. In addition, motivational stimulation can also temporarily improve attention in patients with neglect. (15,16)
Rewellio and the need for being consistent
One main goal of rewellio is to provide an easy and motivational mobile home-based exercise program.
We know that keeping up the motivation for something that is oftentimes hard work can be exhausting. By using gaming and other motivational strategies, as well as monitoring your practice and improvement, we want to guide you on your rehabilitation journey. Rewellio uses the knowledge that motoring patients practice sessions can improve data reliability and is more efficient than self-report. Through our dashboard, you can track your improvements and motivate yourself for the next goals. (17)
The extra push from outside
What do you think, does accountability make you more efficient? Is there anything we can help to keep out your rehab motivation?
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- Dallolio, L., Messina, R., Calugi, S., Fugazzaro, S., Bardelli, R., Rucci, P., … Pagliacci, D. (2018). Self-management and self-efficacy in stroke survivors: Validation of the Italian version of the Stroke Self-Efficacy Questionnaire. European Journal of Physical and Rehabilitation Medicine, 54(1), 68–74. https://doi.org/10.23736/S1973-9087.16.04451-8
- Warner, G., Packer, T., Villeneuve, M., Audulv, A., & Versnel, J. (2015). A systematic review of the effectiveness of stroke self-management programs for improving function and participation outcomes: self-management programs for stroke survivors. Disability and Rehabilitation, 37(23), 2141–2163. https://doi.org/10.3109/09638288.2014.996674
- Korpershoek, C., van der Bijl, J., & Hafsteinsdóttir, T. B. (2011). Self-efficacy and its influence on recovery of patients with stroke: a systematic review. Journal of Advanced Nursing, 67(9), 1876–1894. https://doi.org/10.1111/j.1365-2648.2011.05659.x
- Oussedik, E., Cline, A., Su, J. J., Masicampo, E., Kammrath, L. K., Ip, E., & Feldman, S. R. (2019). Accountability in patient adherence. Patient Preference and Adherence, Volume 13, 1511–1517. https://doi.org/10.2147/PPA.S213113
- Luker, J., Lynch, E., Bernhardsson, S., Bennett, L., & Bernhardt, J. (2015). Stroke Survivors’ Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Studies. Archives of Physical Medicine and Rehabilitation, 96(9), 1698-1708.e10. https://doi.org/10.1016/j.apmr.2015.03.017
- Parke, H. L., Epiphaniou, E., Pearce, G., Taylor, S. J. C., Sheikh, A., Griffiths, C. J., … Pinnock, H. (2015). Self-management support interventions for stroke survivors: A systematic meta-review. PLoS ONE, 10(7), 1–23. https://doi.org/10.1371/journal.pone.0131448
- Nott, M., Wiseman, L., Seymour, T., Pike, S., Cuming, T., & Wall, G. (2019). Stroke self-management and the role of self-efficacy. Disability and Rehabilitation, 1–10. https://doi.org/10.1080/09638288.2019.1666431
- Schneider, E. J., Lannin, N. A., Ada, L., & Schmidt, J. (2016). Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review. Journal of Physiotherapy, 62(4), 182–187. https://doi.org/10.1016/j.jphys.2016.08.006
- Vloothuis, J. D., Mulder, M., Veerbeek, J. M., Konijnenbelt, M., Visser-Meily, J. M., Ket, J. C., … van Wegen, E. E. (2016). Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database of Systematic Reviews, (12). https://doi.org/10.1002/14651858.CD011058.pub2
- Mahmood, A., Blaizy, V., Verma, A., Stephen Sequeira, J., Saha, D., Ramachandran, S., … Solomon, J. M. (2019). Acceptability and Attitude towards a Mobile-Based Home Exercise Program among Stroke Survivors and Caregivers: A Cross-Sectional Study. International Journal of Telemedicine and Applications, 2019, 1–6. https://doi.org/10.1155/2019/5903106
- Donoso Brown, E. V., Dudgeon, B. J., Gutman, K., Moritz, C. T., & McCoy, S. W. (2015). Understanding upper extremity home programs and the use of gaming technology for persons after stroke. Disability and Health Journal, 8(4), 507–513. https://doi.org/10.1016/j.dhjo.2015.03.007
- Burridge, J. H., Lee, A. C. W., Turk, R., Stokes, M., Whitall, J., Vaidyanathan, R., … Yardley, L. (2017). Telehealth, Wearable Sensors, and the Internet. Journal of Neurologic Physical Therapy, 41, S32–S38. https://doi.org/10.1097/NPT.0000000000000183
- Miller, K. K., Porter, R. E., DeBaun-Sprague, E., Van Puymbroeck, M., & Schmid, A. A. (2017). Exercise after Stroke: Patient Adherence and Beliefs after Discharge from Rehabilitation. Topics in Stroke Rehabilitation, 24(2), 142–148. https://doi.org/10.1080/10749357.2016.1200292
- Oussedik, E., Foy, C. G., Masicampo, E. J., Kammrath, L. K., Anderson, R. E., & Feldman, S. R. (2017). Accountability: a missing construct in models of adherence behavior and in clinical practice. Patient Preference and Adherence, Volume 11, 1285–1294. https://doi.org/10.2147/PPA.S135895
- Di Domenico, S. I., & Ryan, R. M. (2017). The emerging neuroscience of intrinsic motivation: A new frontier in self-determination research. Frontiers in Human Neuroscience, 11(March), 1–14. https://doi.org/10.3389/fnhum.2017.00145
- Olgiati, E., Russell, C., Soto, D., & Malhotra, P. (2016). Motivation and attention following hemispheric stroke. In Progress in Brain Research Volume 229 (pp. 343–366). https://doi.org/10.1016/bs.pbr.2016.06.011
- Levy, T., Killington, M., Lannin, N., & Crotty, M. (2019). Viability of using a computer tablet to monitor an upper limb home exercise program in stroke. Physiotherapy Theory and Practice, 1–11. https://doi.org/10.1080/09593985.2019.1625092