Sadler Euan, Wolfe Charles D A, Jones Fiona, McKevitt Christopher
Health Service and Population Research Department, King's Improvement Science, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, London, UK.
BMJ Open. 2017 Mar 10;7(3):e011631. doi: 10.1136/bmjopen-2016-011631.
Stroke is a sudden-onset condition with long-term consequences. Self-management could help address long-term consequences of stroke. Stroke survivors' and health professionals' views of self-management may vary, limiting the successful introduction of self-management strategies. This paper explores stroke survivors' and physiotherapists' views of self-management, focusing on what self-management means, and factors perceived to enable and hinder self-management after stroke, to draw out implications for policy, practice and future research.
Qualitative study using semistructured interviews and a thematic analysis approach.
Stroke unit and community stroke-rehabilitation services in London, UK.
13 stroke survivors (8 men and 5 women; aged 53-89 years) admitted to a London stroke unit. 13 physiotherapists: 8 working in an inpatient stroke unit and 5 in community rehabilitation.
Key differences were evident in how self-management was understood between these groups. Stroke survivors were unfamiliar with the term self-management, but most could provide their own definition and relate to the term, and understood it as care of the self: 'doing things for yourself' and 'looking after yourself'. They did not recognise self-management as part of their care, but valued therapists as encouraging experts in supporting their recovery after stroke. Physiotherapists commonly understood self-management as a process in which stroke survivors were expected to take an active role in their rehabilitation and manage their recovery and health, with different understandings of self-management among physiotherapists shaped by the context in which they worked. They reported that individual, social and organisational factors enable and hinder self-management after stroke, with individual and organisational barriers particularly evident in the early stages.
If self-management support approaches are to be used, further work is required to explore the language and strategies used by professionals to support self-management, and the barriers to supporting self-management at different time points after stroke.
中风是一种起病突然且会产生长期后果的疾病。自我管理有助于应对中风的长期后果。中风幸存者和健康专业人员对自我管理的看法可能存在差异，这限制了自我管理策略的成功推行。本文探讨中风幸存者和物理治疗师对自我管理的看法，重点关注自我管理的含义，以及中风后被认为促进和阻碍自我管理的因素，以得出对政策、实践和未来研究的启示。
采用半结构化访谈和主题分析方法的定性研究。
英国伦敦的中风单元和社区中风康复服务机构。
13名入住伦敦中风单元的中风幸存者（8名男性和5名女性；年龄53 - 89岁）。13名物理治疗师：8名在中风住院单元工作，5名在社区康复机构工作。
这些群体对自我管理的理解存在明显的关键差异。中风幸存者不熟悉自我管理这个术语，但大多数人能够给出自己的定义并与该术语相关联，将其理解为自我照顾：“为自己做事”和“照顾好自己”。他们不认为自我管理是其护理的一部分，但重视治疗师作为鼓励他们中风后康复的专家。物理治疗师通常将自我管理理解为一个过程，即中风幸存者应在康复中发挥积极作用并管理自己的康复和健康，不同的物理治疗师对自我管理的理解因其工作环境而异。他们报告说，个人、社会和组织因素在中风后促进和阻碍自我管理，个人和组织障碍在早期尤为明显。
如果要采用自我管理支持方法，需要进一步开展工作，以探索专业人员用于支持自我管理的语言和策略，以及中风后不同时间点支持自我管理的障碍。
