How our services create impact

Our service activities enable change for people affected by stroke, carers and those around them. The diagram below describes these changes and the impacts for both individuals and the wider health and social care system.

Find out below how research supports our activities, and how they contribute to positive outcomes for stroke survivors and carers.

Provide coordinated support

Research emphasises the importance of coordination and continuity of care for patients with complex needs and long term conditions. This evidence suggests people with multiple long term conditions can benefit from greater predictability of support (1), better experience of and satisfaction with services (2), leading to ultimately improved quality of life.

‘The continuity of the Stroke Association's services and the ongoing relationship with the coordinator is valued, enabling a continuous source of support whilst other services may be more time-limited. The companionship and rapport stroke survivors and carers had with their coordinator was important in alleviating a sense of being alone when managing recovery after stroke.’ (3)

Carry out a holistic needs assessment

Research suggests that a holistic needs assessment can facilitate a person-centred approach with significant benefits. By being more involved in decisions about their care, people are more likely to receive support appropriate to their needs (4). This can both improve people’s health outcomes and reduce how often people use services, reducing the overall cost of care (5).

‘The ability of the service to support people across a wide range of needs (either directly, or indirectly through signposting and advocacy) is a valued aspect of the services. So too is the way the services provide joint or one-to-one support to stroke survivors and their carers.’ (6)

Support recovery and self-management

Self-management (7) is a term which covers a range of interventions and approaches. Recovery planning and goal setting, shared decision-making and motivational interviewing are all associated with positive outcomes for patients with chronic conditions (8):

  • Goal setting and action planning can increase patient adherence to therapy programmes and increase confidence to engage in meaningful activities (9).
  • Evidence-based decision-aids and question prompts can improve service user knowledge and experience (10).
  • Motivational interviewing can enhance individuals’ readiness to make changes in health behaviour and therefore improve stroke survivors’ mood and reduce mortality 12 months post-stroke (11).

‘The Stroke Association's approach of developing a recovery plan based on identifying individual needs and desired outcomes, and tracking progress at regular review points, is seen as a useful aid to recovery.’ (12)

Promote independence and support carers

Home visits and carers’ support can have positive outcomes:

  • Home-based support and advice may result in improved knowledge, satisfaction and mood of service users.
  • Providing information, education and opportunities to connect with caregiving peers can have a positive impact on carers (13).

‘Carers reported that caring for someone initially left them feeling anxious and lacking in confidence. In this regard, they found the informational, practical and emotional support received from coordinators particularly helpful.’ (14)

Help people manage and sustain healthy living

Support to adopt and sustain healthy behaviours and support to re-engage with life outside the home, including with peers, are associated with positive outcomes for people affected by stroke.

  • Breaking activities into small steps and providing ongoing positive, personalised feedback can help people sustain behaviour change (15).
  • Supporting people affected by stroke to engage with meaningful social activities can help them reintegrate into the community (16).
  • Leisure programmes that encourage positivity and acceptance of limitations may help reduce psychological distress (17).
  • Peer support has been associated with improvements in reduced distress(18), as well as improved quality of life, confidence and self-care (19).

‘Support groups were a common source of support for stroke survivors, often hosted by or connected to the Stroke Association, and the Stroke Support Coordinator was instrumental in encouraging stroke survivors to attend.’ (20)

Our document, The Value of our Services, examines the impact that our Stroke Recovery Services have on an individual, and includes information about the potential saving our service has on our health and social care system at a local and national scale.

Read more

Find out more

To enquire about or commission the Stroke Association's services, please contact us at services@stroke.org.uk.

If you are a stroke survivor or carer who would like to know what support is available to you, please contact the Stroke Helpline.

References

(1) Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CF, McKendry R. (2003), Continuity of care: a multidisciplinary review. BMJ;327:1219-21.

(2) Naylor, C., Imison, C., Addicott, R., Buck, D., Goodwin, N., Harrison, T., Ross, S., Sonola, L., Tian, Y., and Curry, N. (2015), Transforming our health care system: ten priorities for commissioners, The King’s Fund.

(3) Wright, D. (2016), An exploratory study of the value and impact of the Stroke Association’s Stroke Recovery Service to stroke survivors and carers: Final Report.

(4) McMillan SS, Kendall E, Sav A, King MA, Whitty JA, Kelly F, Wheeler AJ. Patient-centered approaches to health care: a systematic review of randomized controlled trials. Med Care Res Rev (published online July 2013).

(5) Wood et al,. (2016), At the heart of health: Realising the value of people and communities. Nesta and the Health Foundation.

(6) Wright, D. (2016), An exploratory study of the value and impact of the Stroke Association’s Stroke Recovery Service to stroke survivors and carers: Final Report.

(7) Parke HL, Epiphaniou E, Pearce G, Taylor SJ, et al. (2015), Self-Management Support Interventions for Stroke Survivors: A Systematic Meta-Review. PLoS One, 10, e0131448.

(8) Levack WM, Weatherall M, Hay-Smith EJ, Dean SG, et al. (2015), Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation. Cochrane Database of Systematic Reviews, CD009727.

(9) Sheeba Rosewilliam, Carolyn Anne Roskell and AD Pandyan, (2011), A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011 25: 501.

(10) Supporting shared decision-making - Summarising evidence from systematic reviews (n.d). National Voices – People shaping health and social care.

(11) Lundahl, B., Moleni, T., Burke, B. L., Butters, R., Tollefson, D., Butler, C., & Rollnick, S. (2013), Motivational interviewing in medical care settings: A systematic review and meta-analysis of randomized controlled trials. Patient Education and Counseling, 93, 157–168.

(12) Wright, D. (2016), An exploratory study of the value and impact of the Stroke Association’s Stroke Recovery Service to stroke survivors and carers: Final Report.

(13) Smith J, Forster A, House A, Knapp P, Wright J, Young J. (2008), Information provision for stroke patients and their caregivers. Cochrane Database Syst Rev. 2008 Apr 16.

(14) Wright, D. (2016), An exploratory study of the value and impact of the Stroke Association’s Stroke Recovery Service to stroke survivors and carers: Final Report.

(15) Nesta (2016), Supporting self-management: A guide to enabling behaviour change for health and wellbeing using person- and community-centred approaches.

(16) Woodman P, Riazi A, Pereira C, Jones F. (2014), Social participation post stroke: a meta-ethnographic review of the experiences and views of community-dwelling stroke survivors. Disabil Rehabil. 2014;36(24):2031-43.

(17) Salter, K., et al. (2016), Community reintergration. EBRSR.

(18) Stamatakis, Christopher (2015), The efficacy of peer support in stroke rehabilitation. ClinPsy Thesis, Cardiff University.

(19) Hislop, J., et al. (2016), Evidence summaries for shortlisted interventions (forms one of the annexes to the report At the heart of health: Realising the value of people and communities) Institute of Health & Society, Newcastle University.

(20) Wright, D. (2016), An exploratory study of the value and impact of the Stroke Association’s Stroke Recovery Service to stroke survivors and carers: Final Report.

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