Self-management: skills for life after stroke

By

Sheila Lennon, Emeritus Professor of Physiotherapy, Flinders University, Adelaide, SA, APAM

Sarah Amesz, Acute Allied Health Manager, Bunbury Hospital, WACHS-SW, WA, APAM

What is self-management?

Australian guidelines for stroke care recommend that stroke survivors should be offered supported self - management but what exactly does self-management mean?

Self-management is about gaining knowledge, skills and developing the attitude to help you live the life that you aspire to after stroke by managing your own health and care effectively. Self-management does not mean being left to get on with things yourself, it’s about working with your health care team to help you do the things that are important to you. Self-management helps you to take the leading role in dealing with your condition by making decisions about your healthcare and choosing more healthy behaviours.

Why is it important for you to take self-management on board?

The research for self-management in stroke is growing rapidly. A recent summary [1] found benefits in 11 out of 24 trials in support of self-management programs. Many self-management programs are based on improving self-efficacy; which is your belief in your ability to change or succeed. It can affect how much effort you put into achieving your goals and your ability to deal with challenges and difficulties following a stroke.

You can build up your self - efficacy skills by:

• Setting your own goals and working out small steps to achieve them
• Reviewing your progress to help you to experience success
• Getting feedback from trying different activities
• Keeping track of progress in a diary
• Talking to other people, and seeing or hearing about others’ achievements through peer support.

Research suggests that stroke survivors who take part in a self-management program report better self-efficacy, improved quality of life and improved physical ability. This type of self-management training has been used very successfully since the 1980s with other chronic conditions.

How can you access supported self-management on your stroke journey?

Self-management approaches usually teach skills such as decision making, problem solving, reflection or goal setting. Self-management skills [see Figure 1] can be included in your rehab program, or a self-management program can also be offered in a group setting in your community. Talk to your health care professionals about a self-management program and/or explore the Stroke Foundation enable me website for more information on developing skills such as goal setting. You can also access some further information on self-management at: http://selfhelp4stroke.org/

Figure 1: Some key strategies for successful self-management [3]

Stepping Stones to Self Management

Self-management helps you to gain confidence in managing your symptoms, problems and issues related to your stroke. Your health care professionals are there to provide support and guidance on your stroke journey in a such a way that that enables you to experience success and gain confidence.

• Work with your health care team to develop your care plan. Tell them what is most important to you in your life now.
• Become an expert in your condition. Talk about your concerns and aspirations.
• Outline your treatment expectations and preferences. What do you want to get out of your rehab program?
• Set yourself some goals and develop an action plan to achieve them.
  Connect your goals to the life you want to lead after stroke. What would be the most meaningful for you? Take on your goal in small steps. What are you going to try and work on? How? When? Think about what needs to happen for you to get your exercises done.
• Seek help from your family and friends or think about joining a peer support group with other stroke survivors. Explore your community resources.
• Reflect on your progress and celebrate your achievements, why not keep a journal!
• Work towards improving your general health & fitness, think wellness rather than illness
  Eat well, sleep well, minimise stress, be active & exercise.
  

References:

1. Wray, F, Clarke, D and Forster, A (2017) Post-stroke self-management interventions: a systematic review of effectiveness and investigation of the inclusion of stroke survivors with aphasia. Disability and Rehabilitation, 40 (11): 1237-1251.
2. Jones, F., Gage, H., Drummond, A., Bhalla, A., Grant, R., Lennon, S., et al., Feasibility study of an integrated stroke self-management programme: a cluster-randomised controlled trial. BMJ Open, 2016b. 6: e008900.
3. Sadler, E., et al., Developing a novel peer support intervention to promote resilience after stroke. Health and Social Care in the Community, 2016. 04 March 2016 (Epub ahead of print), 11 pages.