'Getting the Balance between Encouragement and Taking Over' - Reflections on Using a New Stroke Self-Management Programme

BACKGROUND AND PURPOSE: This paper presents findings from a study which aimed to explore contextual, personal and professional factors in applying training in the use of a new stroke self-management programme. METHODS: Practitioners completed in-depth case reflections as part of their two-day training in the Bridges stroke self-management programme (SSMP). The study utilized a qualitative approach to explore the understanding and meaning participants gave to their experiences of using the SSMP. Data from case reflections were analysed using a thematic content analysis. RESULTS: Data from 60 case reflections were included in the analysis. Several themes were prominent including: timing, belief in the concept of self-management, congruence with goal setting, balance of power and subtleties and sensitivities of using the SSMP. The use of in-depth case reflections enabled a personal awareness of the complexities of supporting self-management after stroke. Participants reflected on their communication styles and interactions and how they influence the development of self-management skills in individuals post-stroke. CONCLUSION: Case reflections offered an opportunity for participants who had received training in the use of an SSMP to explore their experiences of using the programme with individuals post-stroke. This enabled personal reflection on learning and facilitated a wider discussion on the professional and organizational context concerning integration of a self-management programme into stroke rehabilitation. The paradox between professionals having a role as 'experts' and the subtle changes in practice towards a more collaborative therapeutic relationship to support self-management needs further exploration. IMPLICATION FOR PRACTICE: Physiotherapists were required to make a change in their practice from traditional, educational, hands on approaches to one which gave more prominence to facilitating an individual's problem solving, collaborative goal setting and decision-making post-stroke. This study highlights a number of issues relevant to professional learning and education in respect of self-management. Copyright © 2012 John Wiley & Sons, Ltd

The stroke self-efficacy questionnaire: measuring individual confidence in functional performance after stroke

Aims and objectives. The aim was to develop a questionnaire for use by practitioners working in stroke care to measure self-efficacy judgements in specific domains of functioning relevant to individuals following stroke. Background. The prevalence of stroke is set to rise across the developed world especially amongst the elderly population. Recovery and adjustment in the longer term can be affected by many different factors. Current objective measures of functional performance used in many stroke programmes may not fully explain the extent of personal levels of confidence that could ultimately influence outcome. Methods. Three separate studies were conducted to develop the Stroke Self-Efficacy Questionnaire. A total of 112 stroke survivors, between 2 and 24 weeks, poststroke participated in the study. Development of the scale was undertaken between 2004 and 2006. Results. The final 13-item Stroke Self-Efficacy Questionnaire was found to have good face validity and feasibility to use in the recovery period following stroke. Cronbach Alpha was 0.90 suggesting good internal consistency, and criterion validity was high compared with the Falls Efficacy Scale, r = 0.803, p < 0.001. The Stroke Self-Efficacy Questionnaire was also able to discriminate between those participants walking and not walking. Conclusions. Preliminary psychometric testing of the new Stroke Self-Efficacy Questionnaire has indicated that it is a valid measure of confidence for functional performance and aspects of self-management relevant for individuals recovering from stroke. Relevance to clinical practice. The Stroke Self-Efficacy Questionnaire could assist clinicians and researchers working in acute stroke care and rehabilitation to screen levels of confidence of stroke survivors in relation to functional performance and self-management. The Stroke Self-Efficacy Questionnaire could be used as part of battery of stroke outcome measures to provide a more comprehensive overview of factors influencing performance in the individuals recovering from a stroke

The 'Choice and Autonomy Framework' : implications for occupational therapy practice

Introduction This paper presents findings from a PhD study exploring autonomy of adults with physical disability. The plethora of descriptions of autonomy in psychological, occupational therapy and rehabilitation literature (e.g. Ryan and Deci 2000, Rogers 1982, Cardol et al 2002) detracts from the centrality of autonomy and results in difficulty incorporating it into occupational therapy practice. This paper presents a framework providing an integrated, clinically useful approach to autonomy. Methods Sixteen people were recruited, based on age, gender, impairment and living circumstances (community/residential settings). All have significant physical disability, use a wheelchair and require personal assistance for some/all self-care activities. Qualitative methods were used for data collection, including life-history narrative, diary information and extensive interview. An integrated method of analysis was used, including content analysis and bracketing. Results The ‘Choice and Autonomy Framework’ consists of five strands, including: • the meaning of autonomy • whether or not autonomy is a goal or value • the experience of autonomy • personality factors that impact autonomy • environmental features that enhance or negate autonomy. This paper will describe each strand, as derived from the research. The results suggest that, contrary to common wisdom (Hmel and Pincus 2002), autonomy is not necessarily a universal goal for people with physical disability; an understanding of the person’s own perspective will enhance person-centred practice and enable therapists to further recognise individuality of clients. It will argue that the concept of autonomy needs to be further understood and incorporated into occupational therapy practice