Self-Management Support Interventions for Stroke Survivors: A Systematic Meta-Review.

Hannah L Parke,Hilary Pinnock,Trish Greenhalgh,Stephanie J C Taylor,Chris J Griffiths,Aziz Sheikh,Eleni Epiphaniou,Gemma Pearce,Antje Timmer

doi:10.1371/journal.pone.0131448

Abstract

BackgroundThere is considerable policy interest in promoting self-management in patients with long-term conditions, but it remains uncertain whether these interventions are effective in stroke patients.DesignSystematic meta-review of the evidence for self-management support interventions with stroke survivors to inform provision of healthcare services.MethodsWe searched MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, BNI, Database of s of Reviews for Effectiveness, and Cochrane Database of Systematic Reviews for systematic reviews of self-management support interventions for stroke survivors. Quality was assessed using the R-AMSTAR tool, and data extracted using a customised data extraction form. We undertook a narrative synthesis of the reviews' findings.ResultsFrom 12,400 titles we selected 13 systematic reviews (published 2003-2012) representing 101 individual trials. Although the term ‘self-management’ was rarely used, key elements of self-management support such as goal setting, action planning, and problem solving were core components of therapy rehabilitation interventions. We found high quality evidence that supported self-management in the context of therapy rehabilitation delivered soon after the stroke event resulted in short-term (< 1 year) improvements in basic and extended activities of daily living, and a reduction in poor outcomes (dependence/death). There is some evidence that rehabilitation and problem solving interventions facilitated reintegration into the community.ConclusionsSelf-management terminology is rarely used in the context of stroke. However, therapy rehabilitation currently successfully delivers elements of self-management support to stroke survivors and their caregivers with improved outcomes. Future research should focus on managing the emotional, medical and social tasks of long-term survivorship.

Highlights

We found high quality evidence that supported self-management in the context of therapy rehabilitation delivered soon after the stroke event resulted in short-term (< 1 year) improvements in basic and extended activities of daily living, and a reduction in poor outcomes
Self-management terminology is rarely used in the context of stroke
The only review that searched for interventions described as self-management,[28] did not identify any randomised controlled trials (RCTs) delivered to stroke survivors, suggesting that there is a paucity of evidence exploring the concept of ‘self-management’ within stroke care

Summary

Introduction

The incidence of stroke continues to rise in low- and middle-income countries,[1] and it is declining in high-income countries, demographic changes and improved survival means the overall numbers of people living with stroke is high and likely to increase. [2] One in 20 adults in high income countries are affected by stroke,[1] and one in three stroke survivors are left permanently disabled, placing a large burden on health and social care. [3,4,5]Promotion of self-management is a core response of healthcare systems globally to the challenge of long-term condition (LTC) survivorship.[5,6,7] Currently, available support for selfmanagement ranges from the provision of disease-specific information via a website or leaflet, [8] to extensive generic programmes such as the UK Expert Patient Programme, which aims to promote behavioural change by building the confidence of individuals to manage their condition and the biopsychosocial impact of living with a LTC.[9]. “Self-management is defined as the tasks that individuals must undertake to live with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management and emotional management of their conditions.”. Role and emotional tasks have been described by Corbin and Strauss as the core components of the management of LTCs.[11] Self-management support in the context of stroke survivorship should aim to empower individuals with the skills to: (1) manage medical tasks (e.g. secondary stroke prevention); (2) maintain or change behaviours or life roles (e.g. dress oneself, return to work); and (3) deal with emotional consequences of stroke survival (e.g. post-stroke depression). There is considerable policy interest in promoting self-management in patients with longterm conditions, but it remains uncertain whether these interventions are effective in stroke patients.

Results

Discussion

Conclusion