[ARTICLE] The Role of Self-Efficacy in the Recovery Process of Stroke Survivors – Full text

Abstract

Introduction: Belief in one’s personal capabilities are conducive to achieving success and provides additional energy for action. The stronger the conviction of one’s self-efficacy, the higher the self-goals and the stronger the commitment to achieving them, despite any adversities. Our knowledge regarding the role of self-efficacy in post-stroke rehabilitation is still scarce.
Aim of the Study: The study aimed to analyze characteristics related to high self-efficacy levels before and after rehabilitation and to determine the role of self-efficacy in this process.
Materials and Methods: The study involved 99 stroke survivors. Participants’ mental and functional state were assessed using Generalized Self-Efficacy Scale (GSES), Barthel Index (BI), Acceptance of Illness Scale (AIS), Geriatric Depression Scale (GDS), Visual Analogue Scale for Pain (VAS), Instrumental Activities of Daily Living (IADL) and Rivermead Mobility Index (RMI). Patients were evaluated twice: on admission (T₁) and 3 weeks into rehabilitation (T₂).
Results: Patients without self-efficacy improvement after 3 weeks of rehabilitation, on discharge from the ward demonstrated poorer well-being (p = 0.002, Hedges’ g = 0.63, 95% CI [0.24– 1.08]), lower illness acceptance levels (p < 0.001, Hedges’ g = − 0.78, 95% CI [− 1.25 – − 0.41]), poorer functional status in basic activities of daily living (p = 0.003, Hedges’ g = − 0.62, 95% CI [− 1 – − 0.25]), locomotive abilities (p = 0.004, Hedges’ g = − 0.58, 95% CI [− 1.12 – − 0.15]) and instrumental activities of daily living (p = 0.001, Hedges’ g = − 0.71, 95% CI [− 1.15 – − 0.34]).
Conclusion: Self-efficacy level is significantly related to rehabilitation outcomes. A routine self-efficacy assessment during the rehabilitation process seems very important. Patients whose initial self-efficacy is low or remains unchanged despite rehabilitation require special attention. Close cooperation between all members of the therapeutic team is essential to strengthen, at each stage, the sense of self-efficacy in stroke survivors.

Introduction

Sudden change in the life of people after stroke can lead to a wide range of negative psychological and behavioral symptoms, including anxiety, feeling of helplessness and mood disorders.¹ Most patients must face various functional, mental, and social constraints. Reduced mobility is a serious problem, as it hinders the performance of everyday tasks and results in isolation due to job loss and inability to resume pre-stroke leisure activities. Deterioration of the quality of life is inevitable² and often leads to depression.³

Belief in one’s personal capabilities is conducive to achieving success and provides additional energy for action. The stronger the conviction of one’s self-efficacy, the higher the self-goals and the stronger the commitment to achieving them, even in the face of adversities.⁴ On the other hand, a low sense of self-efficacy is associated with depression, anxiety and helplessness, while a lack of self-efficacy can completely reduce one’s motivational potential. The sense of self-efficacy differentiates people in terms of thinking, feeling and acting.⁵

Assessing the level of self-efficacy and working to improve this characteristic can help stroke survivors gain greater control over many important aspects of their disease and improve their chances for better and more sustained rehabilitation effects. There has been growing evidence that interventions aimed at increasing self-efficacy have a significant impact on the efficacy of chronic illness therapy, including stroke therapy, and that physiotherapists may have an important role to fulfill in the process.^6–8

Such an approach fits well with the biopsychosocial model of illness, particularly in the context of patient-centred care. There is now a wealth of evidence supporting its validity as a powerful holistic model which, by increasing attention upon the patient as a person and requiring greater collaboration and sharing of care and resources, has the potential to contribute to a more successful and sustainable healthcare system.⁹ Therefore, the purpose of our study was to analyze the characteristics related to high self-efficacy levels before and after rehabilitation and to determine the role of self-efficacy in the rehabilitation process.[…]

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