Self Efficacy and Stroke Rehabilitation

4th Natalia Alazzawi Year Medical Student University of Liverpool

Stroke
Acute neurological event !! Ischaemic/haemorrhagic in origin !! Leaves varying degrees of neurological deficit !! Affects psychological, social and physical functioning
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Statistics in England (British Heart Foundation, 2008) Incidence of 1st stroke per year Mortality per year No. With morbidity No. That need help with ADLs Cost to economy 72,000 53,000 >900,000 ~450,000 7 Billion/yr

Self Efficacy
!! The

belief an individual has in their ability to successfully perform certain tasks or behaviours in the future through their actions Social Cognitive Theory, Albert Bandura (1986)

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Sources of Self Efficacy

Principle Sources of Self Efficacy Information 1. Personal Accomplishment (Mastering of a task) 2. Vicarious Experiences (Comparison with others) 3. Social Persuasion (Persuasion by others) 4. Physiological & Emotional States (Influence of arousal states) High levels of Self Efficacy
Perception & Performance -Set themselves more challenging tasks -Willing to expend more effort. -Show resilience in the face of failure. -Perceived ability increased -Desirable outcome more favourable Perception & Performance -Sense of hopelessness -Motivation restricted -Perception that they will fail -Reaching favourable outcome is less likely irrespective of objective capability.

Self Efficacy Judgements

Low levels of Self Efficacy

Self Efficacy and Rehabilitation

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Subjective perception of capability can have more influence on behaviour than what is objectively true Knowing a patients level of self efficacy can facilitate in: Assessing psychological wellbeing Understanding mediators of adherence to treatment Predicting outcomes

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1.! 2.! 3.!

Self Efficacy Scales

Numerous scales developed across all areas of medicine, for example;
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Neurology: MS, epilepsy, headaches Chronic diseases: Diabetes, COPD, Arthritis

Current work
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Walton Centre, Liverpool Special Study Module in validating a self efficacy scale for a Neurological Rehabilitation Unit Setting

Participants
!! Patient

inclusion criteria !! Monophasic neurological impairment

Neurological Event Spinal Cord Injury CVA GBS TBI Others Number of participants 13 43 11 17 10

! I am encouraged when others notice my achievements.

1 2 3 4

Strongly Disagree

Strongly Agree

! I can do things to help me adapt to my life.

Strongly Disagree

Strongly Agree

! Doing everyday tasks for myself helps my rehabilitation.

1 Strongly Disagree 2 3 4 Strongly Agree

! I work as part of a team with the therapists.

Strongly Disagree

Strongly Agree

Validating the Self Efficacy Scale

Graph shows a weak positive correlation (r=.228, p=0.180) of the MDLOC subscale internal locus with the Self Efficacy Scale.

Graph showing the negative correlation (r=-.508, p=0.01) between the HADS scores of the 7item depression subscale vs. scores from the 41-item Self Efficacy Scale.

Proposed Innovation
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construct and validate a self efficacy scale specific for stroke patients !! Use this scale to identify self efficacy levels in clinical practice !! Target those with lower self efficacy beliefs
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to improve physical, social and psychological outcome from a rehabilitation programme

Any Questions?

References
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Bandura A. Self Efficacy Mechanism in Human Agency. American Psychologist Feb 1982; Vol 37 No. 2:122-147 Everett B, Salamonson Y, Davidson PM.Banduras exercise self-efficacy scale: Validation in an Australian cardiac rehabilitation setting. International Journal of Nursing Studies 2009 vol. 46: 824829 Dixon G, Thornton EW, Young CA. Perceptions of self-efficacy and rehabilitation among neurologically disabled adults. Clinical rehabilitation 2007; 21: 1-11 Kobau R and DiIorio C. Epilepsy self-management: a comparison of selfefficacy and outcome expectancy for medication adherence and lifestyle behaviors among people with epilepsy. Epilepsy & Behaviour. June 2003; Volume 4 (3): 217-225 The Impact of Barriers and Self-Efficacy on Self-Care Behaviors in Type 2 Diabetes. The Diabetes Educator 2001;Vol. 27, No. 3: 393-404 Robinson-Smith G, Johnston MV, Allen J. Self-Care Self-Efficacy, Quality of Life, and Depression After Stroke. Arch Phys Med Rehabil. April 2000; Vol 81:460-464