Self-management: challenges for allied healthcare professionals in stroke rehabilitation – a focus group study

Survivors self-managing their own rehab can't be any worse than the  current 10% full recovery that professionals get.
http://informahealthcare.com/doi/abs/10.3109/09638288.2014.976717

Ton Satink, Edith H.C. Cup, Bert J. M. de Swart, and Maria W. G. Nijhuis-van der Sanden

¹Department of Occupational Therapy, and

²Research Group Neurorehabilitation, HAN University of Applied Sciences,

Nijmegen

, The Netherlands,

³Scientific Institute for Quality of Health Care, and

⁴Department of Rehabilitation, Radboud University Medical Center,

Nijmegen

, The Netherlands

Address for correspondence:

Ton Satink

, Department Occupational Therapy, HAN University of Applied Sciences,

PO Box 6960, 6503 GL Nijmegen

, The Netherlands. Tel: +31 24 3531150. E-mail: ton.satink@han.nl

Abstract

Purpose: Self-management has become an important concept in stroke rehabilitation. This study explored allied healthcare professionals' (AHPs) perceptions and beliefs regarding the self-management of stroke survivors and their knowledge and skills regarding stroke self-management interventions. Method: Four focus group interviews were conducted with 27 professionals. Verbal questions and mind mapping were used to collect data. A constant comparative framework was used for analysis. Results: The AHPs discussed different levels of post-stroke self-management, depending on factors such as pre-stroke skills, recovery-phases post-stroke and cognitive abilities of the stroke patients. They hesitated about stroke clients' capacities to self-manage. AHPs questioned whether their own attitudes and skills were really supportive for stroke clients' self-management and criticised stroke services as being too medically oriented. They recommended that self-management programmes should focus both on clients and caregivers and be delivered at peoples' homes. Conclusion: Professional perceptions and beliefs are important factors to take into account when implementing stroke self-management programmes. Before professionals can enable stroke survivors to self-manage, they first need support in acquiring knowledge and skills regarding post-stroke self-management. Moreover, professionals could benefit from behavioural change models, and professionals recognised that stroke self-management interventions would be most beneficial when delivered post-discharge at people's homes.Implications for Rehabilitation

• Post-stroke self-management is a learning process with different levels dependent on pre-stroke lifestyle and self-management skills, the post-stroke phase of recovery, the cognitive abilities of stroke survivors and the support of caregivers (co-management).
• Persons with cognitive impairments are not persons who cannot learn to self-manage; rather, they need more specific self-management support.
• Case studies describing the abilities of stroke survivors, who are successful in self-management post-stroke, can help to develop “ability oriented” stroke-illness scripts.
• Addressing “ability oriented” stroke-illness scripts in bachelor and post-graduate education will enhance positive professional beliefs concerning the self-management post-stroke, and will help professionals in coaching in stroke survivors' goal setting in self-management programmes.
• Professionals' account suggests that stroke self-management programmes should also be delivered post-discharge at stroke survivors' own homes.

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