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

Parke, Hannah L; Epiphaniou, Eleni; Pearce, Gemma; Taylor, Stephanie J C; Sheikh, Aziz; Griffiths, Chris; Greenhalgh, Trisha; Pinnock, Hilary

doi:10.1371/journal.pone.0131448

Cited by 120 publications

(118 citation statements)

References 26 publications

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“…In line with other research [14,21,22], the results suggested that a group SMP may have a number of benefits such as peer support, reduced loneliness and shared problem solving. The novel aspect of a group compared to a one-to-one SMP is the addition of peer support.…”

Section: Discussionsupporting

confidence: 89%

“…Similar impacts have been found specifically for stroke by three recent systematic reviews [17,19,21]. Firstly, Parke et al [21] reviewed 13 studies and found high quality evidence for a reduction in dependency and death, improvement in activities of daily living and evidence that the SMPs can facilitate reintegration in the community. Secondly, Lennon et al [19] reviewed 15 studies and found significant improvements in favour of SM, including confidence in recovery, stroke specific quality of life and measures of disability.…”

Section: Introductionsupporting

confidence: 53%

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One size does not fit all – Stroke survivor’s views on group self-management interventions

Clark

Bennett

Ward

et al. 2016

Disability and Rehabilitation

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Introduction: Stroke is the main cause of complex disability in the UK. Many stroke survivors feel abandoned when rehabilitation ends and 59% are left with long-term unmet needs. There is now emerging interest in whether group self-management programs (SMP) specifically for stroke could help. However, more work is required to understand the acceptability of group SMPs to stroke survivors and the factors of concern that could impact efficacy.Purpose: To explore stroke survivor's views on 1) possible benefits of a group SMP 2) possible challenges of a group SMP and 3) when/where to implement a SMP in an individual's stroke journey.Method: 14 stroke survivors took part in semi-structured interviews, which were analysed using an inductive thematic approach.Results: Three main themes were identified in the data: 1) A space to share support 2) it's not a one size fits all problem 3) how's it all going to happen?Conclusion: A group of stroke survivors can provide valuable insight and ideas about how groups should be constructed. To the best of our knowledge, this is the first patient engagement study that explores group SMPs for stroke. In future work, researchers may find it helpful to consider the findings from this study to inform the design of group SMPs.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionsupporting

confidence: 53%

One size does not fit all – Stroke survivor’s views on group self-management interventions

Clark

Bennett

Ward

et al. 2016

Disability and Rehabilitation

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“…This resonates with successful self-management interventions in other chronically disabling conditions (e.g. stroke), that focus on strategies for enabling and improving behaviours and activities of daily living rather than crisis management [16,17]. Qualitative work has highlighted how people with severe COPD struggle with (and adapt to) the change in roles imposed by their condition [18].…”

Section: Difficulty Identifying Early Exacerbationsmentioning

confidence: 90%

Supported self-management for COPD: making progress, but there are still challenges

2016

Self Cite

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@ERSpublications Self-management is not a time-limited intervention but on-going support to help a person live with their condition(s) http://ow.ly/10luZqRespiratory specialists familiar with the success of supported self-management in asthma [1] may be excused for feeling disappointed by the evolution of evidence in chronic obstructive pulmonary disease (COPD). The promise of early studies [2][3][4] was seemingly dashed by a series of negative trials [5,6] and a trial was even terminated early for fear of a detrimental effect [7]. The most recent Cochrane review, however, concludes that interventions to support self-management reduce respiratory-related and all-cause admissions, reduce dyspnoea and improve quality of life [8]. The interventions in the included studies were heterogeneous and complex; and it was not possible to identify the individual components of supported self-management responsible for effective outcomes. A wider review of trial-level data was also unable to identify the most important components [9]. The study by JONKMAN et al. [10] in this issue of the European Respiratory Journal, which explores the characteristics of effective self-management interventions in an individual patient data meta-analysis, is therefore a useful contribution to the literature. Difficulty identifying early exacerbationsIn retrospect, the clues that self-management in COPD would be more challenging than in asthma were already available. From the health service perspective, one of the main goals of self-management is to enable patients to recognise that their condition is deteriorating and take timely, appropriate action that can prevent further development of an exacerbation and reduce the risk of an admission. However, qualitative studies in people with COPD highlight the difficulty people have in distinguishing "bad days" from the onset of an exacerbation, observing that it is "only afterwards that you know you are not well" [11]. When asked about the symptoms that indicate an exacerbation, many patients describe nebulous symptoms of "just feeling rough" [12], an observation that will resonate with any general practitioner who has been asked to visit a COPD patient in the throes of an exacerbation whose complaint is no more specific than "unwell". Analysis of telemonitoring data suggests that it is the minority of patients who can log discrete episodes of increased breathlessness, cough and purulent sputum [13]. Most experience a rolling pattern of on-going symptoms with little clarity on when treatment is appropriate. This difficulty in distinguishing the onset of an exacerbation may be one reason for the negative findings of BUCKNELL et al. [6] in their trial of self-management. They observed that only 42% of participants were "successful self-managers" and, in a post hoc analysis, showed that the intervention was effective in this sub-group. CALVERLEY et al. [14] predicted this difficulty a decade ago from analysis of diary cards from trial participants. Despite an increase in mean symptom scores, on an indi...

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“…These tasks include having the confidence to deal with medical management, role management and emotional management of their conditions." 93 Self-efficacy, an individual's confidence in their ability to carry out a specific task or behavior, is a mediator in the causal pathway between acquiring self-management skills and enactment of self-management behaviors. A systematic review without meta-analysis assessed the effectiveness of self-management strategies on depression, as a secondary end point, after stroke.…”

Section: Management: Self-managementmentioning

confidence: 99%

Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Towfighi¹,

Ovbiagele²,

Husseini³

et al. 2017

Stroke

533

506

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Abstract-Poststroke depression (PSD) is common, affecting approximately one third of stroke survivors at any one time after stroke. Individuals with PSD are at a higher risk for suboptimal recovery, recurrent vascular events, poor quality of life, and mortality. Although PSD is prevalent, uncertainty remains regarding predisposing risk factors and optimal strategies for prevention and treatment. This is the first scientific statement from the American Heart Association on the topic of PSD. Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion. This multispecialty statement provides a comprehensive review of the current evidence and gaps in current knowledge of the epidemiology, pathophysiology, outcomes, management, and prevention of PSD, and provides implications for clinical practice. (Stroke. 2017;48:e30-e43.

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

Cited by 120 publications

References 26 publications

One size does not fit all – Stroke survivor’s views on group self-management interventions

One size does not fit all – Stroke survivor’s views on group self-management interventions

Supported self-management for COPD: making progress, but there are still challenges

Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

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