Self Efficacy and Stroke Rehabilitation

Natalia Alazzawi 4th 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 Statistics in England (British Heart Foundation, 2008) Incidence of 1st stroke per year

72,000

Mortality per year 53,000 No. With morbidity >900,000 No. That need help with ADL’s ~450,000

Cost to economy £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)

Self Efficacy Judgements

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.

Low levels of Self Efficacy

Sources of Self Efficacy

Self Efficacy and Rehabilitation �  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: 1.  Assessing psychological wellbeing 2.  Understanding mediators of adherence to

treatment 3.  Predicting outcomes

Self Efficacy Scales Numerous scales developed across all areas of medicine, for example; �  Neurology: MS, epilepsy, headaches �  Chronic diseases: Diabetes, COPD, Arthritis Current work �  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 Number of participants

Spinal Cord Injury 13 CVA 43 GBS 11 TBI 17 Others 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.

1 2 3 4

Strongly Disagree Strongly Agree

•  Doing everyday tasks for myself helps my rehabilitation.

1 2 3 4

Strongly Disagree Strongly Agree

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

1 2 3 4 Strongly Disagree Strongly Agree

Validating the Self Efficacy Scale

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

Proposed Innovation �  To 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 � Ultimately to improve physical, social and

psychological outcome from a rehabilitation programme

Any Questions?

References �  Bandura A. Self Efficacy Mechanism in Human Agency. American

Psychologist Feb 1982; Vol 37 No. 2:122-147 �  Everett B, Salamonson Y, Davidson PM.Bandura’s exercise self-efficacy

scale: Validation in an Australian cardiac rehabilitation setting. International Journal of Nursing Studies 2009 vol. 46: 824–829

�  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 self-efficacy 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