Fellow: Dr Euan Sadler
There have been many improvements in early hospital stroke care but stroke often has long term consequences. There have been fewer improvements in how we support stroke patients in the long term. One of the new developments in this area is ‘self management’ - ways of helping people with any long term condition to look after the long term effects of their condition in their own way. Although the government is keen to promote self management, there have been few studies of self-management in stroke survivors. Existing studies have shown some benefits, such as improved confidence in managing the consequences of stroke and improved quality of life. However, we know little about what self-management means to stroke survivors and their carers, or how healthcare professionals work with stroke survivors and carers to help them to self-manage the effects of stroke.
Physiotherapists work closely with stroke survivors and their carers to try to improve stroke related disabilities and to promote independence in everyday activities. But we do not know whether or how physiotherapists try to encourage self-management for the long term and how useful this is from stroke survivors’ point of view.
This research aims to develop a new method of teaching self-management skills after stroke. I will first review relevant existing studies of self-management for stroke and other long term conditions. Second, I will observe what self-management support physiotherapists provide to stroke patients and carers in hospital and at home. I will then conduct interviews with physiotherapists and repeat interviews with stroke survivors and carers to understand how they try to manage the effects of stroke over time. I will use the results of these studies to develop and test a new method of promoting self-management, which will aim to improve health and quality of life after stroke.
Despite major policy and NHS initiatives focusing on chronic disease self-management interventions, evidence for their effectiveness on improving health-related outcomes remains equivocal. Few interventions have focused specifically on self-management after stroke. Physiotherapists are integral to the early multidisciplinary rehabilitation of stroke patients. They prepare stroke patients and carers to become more independent after stroke, however, little is known about the nature of self-management support provided by physiotherapists or its acceptability and effectiveness. The aim of this study is to develop an intervention promoting self-management aimed at improving health and quality of life after stroke. In order to do so, this research involves a 3 phase early complex intervention study:
1) A narrative synthesis of evidence on self-management interventions for chronic disease to develop a conceptual framework of the nature, acceptability and outcomes of such interventions for stroke survivors and carers.
2) Longitudinal case studies using observations and interviews to examine the nature of physiotherapists’ involvement in self-management at different phases, and physiotherapists’, stroke survivors’ and carers’ perceptions of self-management needs after stroke.
3) Use the findings from 1 and 2 to develop a pilot intervention promoting self-management and thereby improving health and quality of life after stroke.