Self-management after stroke: time for some more questions?

Abstract

Purpose: To discuss current research and issues which contribute towards the debate on the direction of self-management programmes for individuals after stroke and make recommendations for future research. Method: This paper includes a critical discussion on self-management specifically applied to stroke. The findings are positioned in the context of the wider stroke literature and debates on the suitability of different programmes. Results: Three main areas of concern and potential opportunities were identified which contribute to the debate on self-management; the “individual stroke survivor”; “professional models and practice” and “organizational context”. Conclusion: The body of literature on self-management programmes for people with stroke is relatively new and although research is building many issues are unknown. We have highlighted a number of potential areas of inquiry and concern. In order to further advance the research on stroke and self-management we believe a convergence of the evidence base for chronic disease self-management programmes and research which has illuminated the specific challenges and barriers of living with stroke is warranted. There is also a need to avoid the potential consequence of focusing on a “one-size” programme but rather develop interventions which can be inclusive of social aspects of self-management, and identify new methods of delivery.

Implications for Rehabilitation

• Stroke is a common cause of long-term disability in the developed world

• Self-management programmes designed specifically for people with stroke are rare but research is emerging

• Ongoing research focusing on behaviour change should acknowledge individual needs, professional beliefs and values, as well as the organizational context post-stroke

Keywords::

• Stroke
• self-management
• chronic disease
• disability
• adjustment

Acknowledgements

The authors thank Tess Baird, Lucinda Brimacombe, Crystal Waters and the Bridges stroke self-management advisory group.

Declaration of Interest: The authors report no conflicts of interest.