Pearce Gemma, Pinnock Hilary, Epiphaniou Eleni, Parke Hannah L, Heavey Emily, Griffiths Christopher J, Greenhalgh Trish, Sheikh Aziz, Taylor Stephanie J C
Centre for Technology Enabled Health Research (CTEHR), Coventry University, Coventry, United Kingdom.
Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom.
PLoS One. 2015 Dec 14;10(12):e0141803. doi: 10.1371/journal.pone.0141803. eCollection 2015.
Supporting self-management in stroke patients improves psychological and functional outcomes but evidence on how to achieve this is sparse. We aimed to synthesise evidence from systematic reviews of qualitative studies in an overarching meta-review to inform the delivery and development of self-management support interventions.
We systematically searched eight electronic databases including MEDLINE, EMBASE and CINAHL for qualitative systematic reviews (published January 1993 to June 2012). We included studies exploring patients', carers' or health care professionals' experiences relevant to self-management support following a stroke, including studies describing the lived experience of surviving a stroke. We meta-synthesised the included review findings using a meta-ethnographic framework.
Seven reviews, reporting 130 unique studies, were included. Themes emerging from the reviews were pertinent, consistent and showed data saturation; though explicit mention of self-management support was rare. Our meta-review highlighted the devastating impact of stroke on patients' self-image; the varying needs for self-management support across the trajectory of recovery; the need for psychological and emotional support throughout recovery particularly when physical recovery plateaus; the considerable information needs of patients and carers which also vary across the trajectory of recovery; the importance of good patient-professional communication; the potential benefits of goal-setting and action-planning; and the need for social support which might be met by groups for stroke survivors.
The observed data saturation suggests that, currently, no further qualitative research simply describing the lived experience of stroke is needed; we propose that it would be more useful to focus on qualitative research informing self-management support interventions and their implementation. Our findings demonstrate both the on-going importance of self-management support and the evolving priorities throughout the stages of recovery following a stroke. The challenge now is to ensure these findings inform routine practice and the development of interventions to support self-management amongst stroke survivors.
支持中风患者的自我管理可改善心理和功能结局，但关于如何实现这一点的证据很少。我们旨在通过一项总体元综述，综合定性研究系统评价中的证据，为自我管理支持干预措施的提供和发展提供信息。
我们系统检索了包括MEDLINE、EMBASE和CINAHL在内的八个电子数据库，以查找定性系统评价（发表于1993年1月至2012年6月）。我们纳入了探索中风后与自我管理支持相关的患者、护理人员或医疗保健专业人员经历的研究，包括描述中风幸存者生活经历的研究。我们使用元民族志框架对纳入的综述结果进行了元综合分析。
纳入了七项综述，报告了130项独特的研究。综述中出现的主题相关、一致且显示出数据饱和；尽管很少明确提及自我管理支持。我们的元综述强调了中风对患者自我形象的毁灭性影响；康复过程中对自我管理支持的不同需求；整个康复过程中对心理和情感支持的需求，尤其是在身体康复停滞时；患者和护理人员大量的信息需求，这些需求在康复过程中也有所不同；良好的医患沟通的重要性；目标设定和行动计划的潜在益处；以及中风幸存者群体可能满足的社会支持需求。
观察到的数据饱和表明，目前不需要进一步的定性研究来简单描述中风的生活经历；我们建议，更有用的是专注于为自我管理支持干预措施及其实施提供信息的定性研究。我们的研究结果表明了自我管理支持的持续重要性以及中风后康复各阶段不断变化的优先事项。现在的挑战是确保这些研究结果为常规实践和支持中风幸存者自我管理的干预措施的发展提供信息。
