A scoping review of therapies targeting confidence in stroke survivors

Background & aims: Confidence is a crucial yet poorly understood concept in rehabilitation. Therapies enhancing confidence lack specificity and confidence outcome measures vary. This review aimed to explore therapy techniques designed to impact confidence in stroke survivors, identify outcome measures used to assess confidence and to define the core components of confidence treatments. Particular consideration was given to treatment of confidence in people living with communication disorders, such as aphasia.  Methods: Databases were searched using the scoping review framework. Published, peer reviewed, English language articles focused on stroke rehabilitation with measurements and explorations of confidence/self-efficacy were included. Studies were allocated to treatment category groups based on authors’ descriptions of the intervention. Results: Nine thousand and one records were screened, 516 assessed, and 26 studies included. Studies were categorised into intervention types: self-efficacy, self-management, impairment-based or technology-incorporated interventions, with a few unique, non-recurring approaches (such as drama therapy). Twenty-three quantitative and six qualitative measures were extracted. Quantitative measures included standardized assessments (scales or questionnaires), or study-specific measures. The most common measure was the “Stroke Self-Efficacy Questionnaire”. Conclusion: With respect to treatment components, there were overlaps between many studies. There was not a specific approach that was clearly associated with enhanced confidence outcomes. Rather, interventions implemented elements of multiple approaches. There were a few therapies whose primary focus was improving confidence. Specifically, only three studies explicitly sought out to “regain confidence” or “change self-efficacy” or focus on self-efficacy outcomes. Other studies examined confidence as a secondary outcome. There was a pattern of using general stroke-specific confidence/self-efficacy related outcome measurement tools rather than context/skill specific confidence/self-efficacy measurement tools.  Though confidence is a crucial yet poorly understood concept in neurorehabilitation, this scoping review may contribute towards its development and maturation with the field.