The consort flow diagram (
Across the study period, 25 people recruited from local charities and organisations participated in weekly sessions
at the charity Action After Stroke. Of these, 19 participants were invited to participate, 13 individuals (6 male, 4 female; U = 60.5, p = 0.24) met the inclusion criteria, consented and were included in this study. The average age was 70.7 ± 13.5 years (U = 37.5, p = 0.54) and the average time since stroke was 83.8 ± 92.8 months (U = 20, p = 0.59). The average time at the charity was 10.8 ± 5.9 weeks. All participants had a clinical diagnosis of a cerebrovascular accident. Six participants declined to participate in the study. The primary reason for this was because they were not interested.
A total of 18 participants were available at the stroke club used for the control group. Seven individuals (2 male, 5 female, average age 67.9 ± 9.4 years) volunteered to represent the control group. The average time since stroke was 28.8 ± 18.7 months. All participants had a clinical diagnosis of having a cerebrovascular accident no further details were obtained. Limitations in access to a control group meant this fell short of the 12 participants hoped for; this is a key limitation of the current work. A table of all participant demographics is available from the supplementary files online.
The eight participants completed one interview. The average (mean) age was 70 years (standard deviation (SD) 11.41); time since stroke, 6.25 years (SD 7.17); and time at charity, 14.3 (SD 3.4), and there were exactly 1:1 (female: male).
On average individuals attended 6.9 ± 2.5 sessions out of the possible 11 on offer. There was only two occasions when individuals provided a medical reason for not attending (either reporting a fall or medical illness). There were several occurrences when the bus service used to support individuals did not pick them up and so they missed the session. This is important because it would affect a large number of individuals (n = 8) who attended by this means. Other factors that influenced retention were the challenges experienced in having individuals complete the questionnaire after the session or having to prompt individuals (n = 3) to complete the questionnaires. Trial retention is show in
Two individuals left the club after the first data collection and did not return. In the final data collection a further two individuals were ill. The main limitation to retention was ability to access group. For instance participants contact details were not provided.
Results from the SEQ (Jones et al., 2008) revealed little change in both groups across time, although both groups had large confidence intervals. The control group was noticeably lower scores across times. Interestingly the FES (Hauer et al., 2011) questionnaire identified a small positive change in self-efficacy in the intervention group after 11 weeks from the study, at the same time a small negative change occurred in the control group. However, within the intervention group results returned to baseline levels at 22 and 52 weeks assessments. Results from the SISI (Postmes et al., 2013) were the most positive showing a consistent improvement in the intervention group across each time period (weeks 22 and weeks 52 were very similar). In contrast the control group identified a reduction in identity levels at week 11 and a similar score to baseline at week 22.
Three sub-themes relating to confidence and social identity were identified as benefits from the group, these domains included; psychological, quality of life and social. Within the psychological benefit there were 4 codes
| Outcome | Week | Intervention mean ± SD CI sample size (n) | Control mean ± SD CI sample size (n) |
|---|---|---|---|
| Self-efficacy | Baseline | 65.1 ± 37.9 CI: 44.5 - 85.7 n = 13 | 48.8 ± 23.0 CI: 30.4 - 67.2 n = 6 |
| 11 | 65.1 ± 32.0 CI: 47.0 - 83.2 n = 13 | 46.5 ± 23.1 CI: 28.0 - 65.0 n = 6 | |
| 22 | 60.9 ± 38.3 CI: 37.2 - 84.7 n = 13 | 52.3 ± 25.0 CI: 28.3 - 77.2 n = 4 | |
| 52 | 65.7 ± 39.9 CI: 43.2 - 88.3 n = 12 | ||
| Falls self - efficacy | Baseline | 15.7 ± 7.11 CI: 11.5 - 19.9 n = 11 | 20.3 ± 1.9 CI: 18.8 - 21.8 n = 6 |
| 11 | 17.3 ± 6.3 CI: 13.8 - 20.7 n = 13 | 19.8 ± 2.7 CI: 17.7 - 22.0 n = 6 | |
| 22 | 16.0 ± 7.0 CI: 12.0 - 20.0 n = 12 | 20.5 ± 1.9 CI: 18.6 - 22.4 n = 4 | |
| 52 | 15.9 ± 7.6 CI: 11.6 - 20.2 n = 12 | ||
| Identity | Baseline | 5.5 ± 0.72 CI: 5.1 - 5.9 n = 13 | 5.8 ± 1.4 CI: 4.7 - 6.9 n = 6 |
| 11 | 5.7 ± 0.75 CI: 5.3 - 6.1 n = 13 | 5.1 ± 2.0 CI: 3.5 - 6.7 n = 6 | |
| 22 | 6.0 ± 0.92 CI: 5.5 - 6.5 n = 12 | 5.7 ± 1.55 CI: 4.2 - 7.2 n = 4 | |
| 52 | 5.9 ± 1.05 CI: 5.3 - 6.5 n = 10 |
or units identified by participants as benefits; (a) improvements in an individual’s social confidence (4/8 participants). Importantly this is different from the SEQ as that refers to the confidence to complete certain tasks. (b) confidence gained from positive social comparisons (4/8 participants) with peers and the instructor. This aided the ability for individual to cope through being able to use strategies such as benefit finding or positive reappraisal of their own situation. (c) just attending the group allowed individuals were able to acknowledge their current ability (2/8 participants) and be more sure about what they could and couldn’t do. (d) the final code identified the value and satisfaction from participants being able to help the student volunteers in their learning (3/8 participants) through direct and unique clinical experience. The second sub-theme related to benefits on an participants quality of life in that, individuals identified that sessions allowed them to engage in a meaningful activity (4/8 participants) by themselves (due to the ring and ride service), this impacted on their independence (a key aspect that influences mental well-being). The third sub-theme identified a social benefit from attending sessions which included four codes; (a) Participants identified receiving emotional and esteem support from individuals which aided their social confidence (4/8 participants). (b) participants reported a benefit in being able to relate to one another as well as experience a bond and unity of belonging to the group (3/8 participants). (c) Participants identified the experience as occurring within a safe environment (2/8 participants) which was important for their confidence to initially attend the sessions. (d) Finally, individual talked about relatedness with others (3/8 participants).
| Subtheme | Code | Example Units | Number of participants identifying code |
|---|---|---|---|
| Psychological Benefit | Confidence | “it hasn’t in as much as coming by ring and ride, coz now I can come on that on my own, you know, which I wouldn’t have done, at first, at all.” (P4) “Coming here gives you a lot more confidence in yourself.” (P2) “Yes, sometimes before I start going here I used to fear to go out. You know, but since I’m coming here I am more guts to go out.” (P3) | P1, P2, P3, P4, P7 4/8 participants |
| Upward social comparison and benefit finding | “I think [the leader] gives you lots of confidence because she’s confident in herself”. (P2) “I think meeting people who have got the same disabilities helps because you can see how they progress, and you are too, progress the same” (P8) Because I see them every week I can see how they progress, and then I can see… (P7) | P1, P2, P7, P8 4/8 participants | |
| Realisation or acknowledgement of ability | “I think it’s helped me realise my limitations, because going round the circuit that [physiotherapist leader’s] done, I usually have to have a rest in between. And its helped me realise that you do have to give into it for a short while and then start again.” (P4) Because I see them every week I can see how they progress, and then I can see… I cant see myself obviously, my progress, but I’ve been told I’m getting better at doing certain activities… with my hand, you know” (P7) | P4, P7 2/8 participants | |
| Being able to help others (student volunteers) by attending | “Yes, that’s it. From the students [volunteers], one exercise… All of it” (P6) “oh definitely yes, because I’m helping them, obviously not helping them but they’re using me and I’m using them”. (P7) “yes, and I think working with the students [volunteers] helps, because a lot of physios, physio sessions iv been to, mainly are for the elderly, and it’s nice to have younger people around you” (P8) | P6,P7,P8 3/8 participants | |
| Quality of life benefit | Meaningful activity which is enjoyable | “I like everything, I go round everything.” (P5) “I look forward to it [coming to charity]” (P7) “it’s given me…something to do on my own” (P4) | P4,P5,P7,P7 4/8 participants |
| Social benefit | Emotional and esteem support increasing social confidence | “It means being able to talk to people and is much easier now with the group because we all talk.” (P1) “I am louder when I am more comfortable with people.”(P3) “…we chat on the bus…and look forward to seeing them” (P2) I can’t see myself obviously, my progress, but I’ve been told I’m getting better at doing certain activities… with my hand, you know” (P7) | P1,P2,P3,P7 4/8 participants |
| Sense of unity and belonging | “Now I feel I belong a lot more” (P1) “it helps me seeing other disabled people” (P7) “I come in and I like [patient at charity]” (P5) | P1,P5,P7 3/8 participants | |
| Safe experience | “The only time I do go out on my own is here, with the ring and ride. And that’s the only time really that I’m on my own” (P4) “As long as there’s someone there to help me it doesn’t stop me going out.” (P2) | P2,P4 2/8 participants | |
| Relatedness and shared experience | “Because you’re meeting other people that have got the same problem as you so you don’t feel like the odd one out.” P2 “Because the people with the same complaint and has helped me because they talking to me and listen to me and hold hands and talk about the decision about the stroke and so I am more confident now”. P3 “Mixing with people with the same sort of disability as myself” (P7) | P2,P3,P7,P8 3/8 participants |