Fu Vivian, Fernando Kathryn Mary, Bright Felicity, Riley Judith, McPherson Kathryn, McNaughton Harry
Medical Research Institute of New Zealand, Wellington, New Zealand.
Stroke Clinical Trials Group, University of Calgary, Calgary, Alberta, Canada.
Clin Rehabil. 2025 Mar;39(3):377-387. doi: 10.1177/02692155241310770. Epub 2025 Feb 2.
ObjectiveThe Take Charge intervention, delivered early after hospital discharge following acute stroke, is effective at improving 12-month health status, independence and advanced activities of daily living. This study aims to provide a deeper understanding of the experiences of receiving Take Charge.DesignThis was a qualitative study nested within a large randomised control trial, the Taking Charge After Stroke (TaCAS) study. Data were analysed using thematic analysis, and we describe our findings using interpretive description.ParticipantsPeople with stroke aged over 18 years, who were participants in the TaCAS study conducted in Aotearoa New Zealand.InterventionTake Charge, a person-centred conversation delivered face-to-face, designed to explore a person's identity and priorities, conducted by a trained facilitator and guided by a workbook.ResultsWe interviewed nine participants, three from each of the three arms of the TaCAS trial - each would have received one, two, or zero Take Charge sessions (the control group). The overall theme of 'Doing things my way/coming to know my own wisdom and expertise' was enabled by 'being listened to and feeling heard' and 'focusing on the goals which were important to me', both strongly expressed by people who received the Take Charge intervention, and hindered by 'medical paternalism' and 'loss of sense of self/"not me"' most commonly expressed by people in the control arm.ConclusionsThe Take Charge intervention empowers people with stroke by enhancing intrinsic motivation. A trusting, therapeutic relationship and non-judgemental facilitation are essential to ensure that the person feels heard.
目的
“掌控自我”干预措施在急性中风出院后早期实施，对改善12个月的健康状况、独立性和高级日常生活活动有效。本研究旨在更深入地了解接受“掌控自我”干预的体验。
设计
这是一项嵌套在大型随机对照试验“中风后掌控自我”（TaCAS）研究中的定性研究。采用主题分析法对数据进行分析，并使用解释性描述来阐述研究结果。
参与者
年龄超过18岁的中风患者，他们是在新西兰奥特亚罗瓦进行的TaCAS研究的参与者。
干预措施
“掌控自我”，这是一种由经过培训的促进者以面对面方式进行的以个人为中心的对话，旨在探索个人的身份和优先事项，并以工作手册为指导。
结果
我们采访了9名参与者，TaCAS试验三个组各有3名——每组分别接受了1次、2次或0次“掌控自我”干预课程（对照组）。“按自己的方式做事/了解自己的智慧和专业知识”这一总体主题因“被倾听并感到被理解”和“关注对我重要的目标”而得以实现，这两点在接受“掌控自我”干预的人群中强烈体现，而“医疗家长作风”和“自我意识丧失/‘不是我自己了’”则对这一主题起到阻碍作用，这两点在对照组人群中最为常见。
结论
“掌控自我”干预措施通过增强内在动力赋予中风患者力量。信任、治疗性的关系以及无评判的引导对于确保患者感到被倾听至关重要。
