Health training following a stroke

J. Liepert¹, P.M. Gollwitzer^2,3 and G. Oettingen^2,4
1 Kliniken Schmieder Allensbach, 2 University of Konstanz,  3 New York University, 4 University of Hamburg

Stroke is the third most frequent cause of death in Germany, and in many patients leads to mental and physical impairments. It also places a considerable financial burden on the health care system (Broeks et al., 1999; Kolominsky-Rabas et al., 2006). The likelihood of relapse lies at 3-5% in the first month and at 10% in the first year following the stroke. To avoid relapse, information and elucidation regarding risk factors and a corresponding change in lifestyle are of central importance (www.dgn.org; www.hochdruckliga.de). In the framework of the study, three health training programs are compared.

The aim is to identify the training program which exerts the most enduring effect on behavioural change in stroke patients. Additionally examined are possible motivational and personal factors which influence the extent and duration of a behavioural change and consequently the success of the health training. All three training programs are carried out in parallel during inpatient neurological rehabilitation in the Kliniken Schmieder in Konstanz, Allensbach and Gailingen. Data are gathered from all participating patients (N = approx. 330) over the period of one year. The data collection encompasses demographic variables, risk factors (blood pressure, weight, blood sugar, cholesterol values, nicotine abuse etc.) as well as motivational and personality factors.


The training programs differ as follows:

• Training 1: Health information is imparted in the form of lectures as has previously been the case in the Kliniken Schmieder. This training serves as the control information.
• Training 2: Health information and corresponding behavioural recommendations are imparted in the form of seminars with theoretical and practical components.
• Training 3: Health information as well as corresponding behavioural recommendations are imparted in the form of seminars with theoretical and practical components.

To strengthen autonomous self-regulation in the implementation of behavioural recommendations, the combined self-regulation strategies of mental contrasting and the formation of implementation intentions are imparted (Stadler, Oettingen & Gollwitzer, 2005).

Mental contrasting (Oettingen, Pak & Schnetter, 2001) leads, with high success expectancies, to a strong goal commitment and to the identification of obstacles to goal attainment. The implementation intentions linked to the obstacles (if-then plans, Gollwitzer, 1999) facilitate the targeted action instruction and shield against possible disruptions of action performance. The imparting of information and the self-regulation intervention is oriented in all three training programs to the central risk factors for a stroke (hypertension, physical inactivity, unfavourable nutritional habits and overweight, stress and everyday drugs).

It is expected that participants of training 3 will show a stronger and longer-lasting change in their health behaviour, and consequently a stronger reduction of risk factors than participants of the other training programs. While the individual changes in the degree of risk factors permit conclusions to be drawn regarding the effectiveness of the respective intervention, the consideration of the intervention outcomes in conjunction with motivational and personality factors leads to further insights regarding their moderating influence. It is expected that a risk profile for patients with low willingness to change their health behaviour will be identifiable.

The data collection is currently underway. The conducted seminars are evaluated by the patients very positively. The willingness to participate is correspondingly high. The participants find the setting to be particularly good and helpful, as the implementation of the training program in small groups fosters the exchange of experiences with other patients, and a greater opportunity to clarify individual questions is offered. So far, the positive evaluation is also reflected in a very good response rate, allowing us to assume a good and successful progression of the project in the future.

Literature

• Broeks JG, Lankhorst GJ, Rumping K, Prevo AJ (1999). The long-term outcome of arm function after stroke: results of a follow-up study. Disabil Rehabil; 21: 357-364.
• Gollwitzer PM (1999). Implementation intentions. Strong effects of simple plans. American Psychologist; 54: 493-503.
• Kolominsky-Rabas PL et al. (2006). Lifetime cost of ischemic stroke in Germany: results and national projections from a population-based stroke registry: the Erlangen Stroke Project. Stroke; 37: 1179-1183.
• Oettingen G, Pak H, Schnetter K (2001). Self-regulation of goal-setting: Turning free fantasies about the future into binding goals. J Personality Soc Psychol; 80: 736-753.
• Stadler, G., Oettingen, G., & Gollwitzer, P.M. (2005). Von der Phantasie zum Ziel zum gesunden Lebensstil. In H. Thomas (Ed.), Selbstregulation von Gesundheitsverhalten (pp. 1-39). Hamburg: Deutsche Angestellten Krankenkasse.