Preliminary Results of a Co-Created Manualized Intervention for Stroke in a Safety-Net Skilled Nursing Facility: Modified Healthy GOALS Study

Abstract

Date Presented 04/03/2025

Health management training poststroke is vital, and OT is well suited for this role. This study presents the feasibility and patient outcomes of a modified Healthy GOALS stroke intervention implemented in a skilled nursing facility (SNF).

Primary Author and Speaker: Valerie Ann Hill

Contributing Authors: Leah Volpenhein, Kelly Calloway, Sophie Louis, Alyssa Snyder, Emily Ciprich

This study preliminarily evaluated the feasibility of the Healthy GOALS intervention (Healthy Goal Achievement through Action Planning and Lifestyle Management after Stroke [HG]) in a skilled nursing facility (SNF [SNF-HG]). Research Questions. 1) How can HG be implemented in a safety-net SNF? 3) Which outcome measures demonstrate a relevant and meaningful change for participants? 4) What modifications are needed to prepare for a pragmatic controlled trial (PCT)? Occupational therapists are uniquely situated to facilitate health management skills; HG offers an evidence-based manual to help implement this in the SNF setting. Developing a pragmatic OT manual for health management after stroke elevates OT practice and improves patients’ health.

DESIGN: Convergent Mixed Methods. Recruitment: OT screened patients at SNF admission, consented, and evaluated participants. Inclusion criteria: diagnosis of stroke or TIA. Exclusion: cognitive impairment. Outcome Measures. Feasibility: VA Quality Enhancement Research Initiative guide to evaluate interventions in healthcare. Interviews with OTs and a review of OT notes were used. Patient outcomes: Stroke Self-Efficacy Questionnaire (SSEQ, stroke confidence scale) and Stroke Impact Scale (SIS, stroke-specific quality of life) were used. Data Analysis Plan. 1) Transcripts coded and implementation data identified. 2) Numerical analysis of treatment data, 3) Content analysis of OT notes, 4) Descriptive data on SSEQ and SIS.

RESULTS: Numerical: Participants had 2-3 treatments and 2 outcome sessions ranging from 28-83 minutes. Content covered: routine, mood, and diabetes-, energy-, stress-, and self-management. Patient outcomes: SSEQ: Self-efficacy and quality of life were elevated from pre to post for P1; P2 had a ceiling effect for both outcomes.

CONCLUSION: The SNF-HG manual guides the expansion of OT practice into condition-specific health management to benefit patients and healthcare systems.

References

Bowersox, N.W., Jedele, J.M., Kawentel, L.M. (2021). Quality Enhancement Research Initiative (QUERI) Evaluation Guide: Developing and Implementing a High-Quality Evaluation. United States Department of Veterans Affairs Health Administration Office of Research and Development. Available at: https://www.queri.research.va.gov/ceir/

Hill, Miller, & Towfighi. (2019). Feasibility of a Community-Based OT-Led Life-Management Intervention for Individuals With Stroke. American Journal of Occupational Therapy, 73(4): 7311515364p1. https://doi.org/10.5014/ajot.2019.73S1-PO5032

Hill, Leugers, Wagner, Miller. (2023). Results of the Healthy GOALS Efficacy Study of a Life Management Intervention on Engagement in Meaningful Activities & Quality of Life Poststroke. American Journal of Occupational Therapy, 77(2): 7711510286p1. https://doi.org/10.5014/ajot.2023.77S2-PO286

Hill. (2018). Live Well After Stroke: Methods of a Community-based, Occupational Therapist-led, Life Management Intervention. Annals of Physical and Rehabilitation Science, 61:e514. https://doi.org/10.1016/j.rehab.2018.05.1197