Self-management: is it time for a new direction in rehabilitation and post stroke care?

Stroke is traditionally thought of as an acute condition and most rehabilitation is provided in the first six months poststroke. To date there has been minimal focus on strategies which could support people in the longer term and manage the transition towards successful adjustment and self-management. Stroke self-management programs whilst rare are now starting to emerge but while the feasibility and acceptability of delivering stroke self-management programs looks to be promising, there are minimal findings beyond phase II trials. A self-management program is a complex intervention and a carefully staged approach to research is required, one which addresses the issues around implementation and the skills required by those delivering the intervention. In addition there are a number of questions relating to maintenance of self-management skills beyond attendance at programs or after rehabilitation. Currently the sustainability of any impact from these programs is uncertain and it is unclear which are the best methods to enhance self-management skills over a longer time period. More work is required in order to develop and test different forms of support which could range from a simple goal setting interventions to more structured self-management programs delivered either as a group or individualized intervention.