self efficacy and stroke rehabilitation
TRANSCRIPT
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
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