Stroke Self-Management Tweet-chat

Sharon D. Anderson
Stroke Survivors Tattler

January 21 / 2015

When: 

• February 10, 2015  5PM GMT(London, UK), 
• 10 AM Mountain Standard Time (Alberta)
• Tweetchat in your Time Zone... 

Tweet Chat Questions:

• T1: What do you think about self-management after stroke? 
• T2: How relevant is self-management after stroke?  Do you think that stroke survivors can manage stroke by themselves?
• T3: What preparation and support do survivors need if they are to self-manage stroke? 
• T4: What are the barriers to self-management after stroke? 

History

Chronic disease self-management programs have a long history.  Perhaps the best known self-management program is Dr. Kate Lorig’s (Stanford University School of Medicine) peer and professionally led Chronic Disease Self-Management (CDSM). It was adopted by Kaiser Permanente in 1997 and by the UK National Health Service as the Expert Patient Program.

• YouTube Video of Kate Lorig speaking about CDSM

Definition

Self-management refers to the strategies, decisions, and activities individuals take to manage a long-term health condition (Bolger, Demain, Latter, 2015).

Goals of Chronic Disease Self-management Programs

Potentially, self-management can reduce both the personal and health service impact of illness.

• Maximizing healthcare 
• Minimize healthcare expenses
• Changing health professionals beliefs about self-management—Empowered patients
• Changing patients views of self-management—Knowledgeable patients

What’s the Evidence? 

• Effectiveness of programs taught by peers  and professionals are about the same
• Changes can be seen for as long as 4 years
• Program length of less than six weeks is not  effective
• Changes in self-efficacy appear to be more  important than changes in individual behaviors
• Less healthcare utilization and lower costs
• Average .8 fewer days in hospital in the past six months (p=.02)
• Trend toward fewer outpatient and ER visits (p=.14)
• Estimated cost of intervention €300

Self-Management: A 30 Year History

Should CDSM programs be General or Disease Specific?

Argument for General Programs for all Chronic Conditions 

• Most people have more than one chronic condition (average 2.2)
• Self-management skills are similar across chronic conditions
• Difficult to get a critical mass of people for disease specific education, especially for rarer diseases

Argument for Disease Specific Programs 

• Condition specific Knowledge is necessary

What is Stroke Self-Management?

Stroke represents a significant health and social burden, yet we really don’t know what elements support successful self-management following stroke.

How Feasible is Stroke Self-Management?

Survivors viewed self-management as an important yet unavoidable feature of life after stroke. They were not prepared to self-manage. (Bolger, Demain, Latter, 2015).

References 

• Boger, E. J., Demain, S. H., & Latter, S. M. (2015). Stroke self-management: A focus group study to identify the factors influencing self-management following stroke. International Journal of Nursing Studies, 52(1), 175-187. 
• Dewan, B., Skrypak, M., Moore, J., & Wainscoat, R. (2014). A service evaluation of the feasibility of a community-based consultant and stroke navigator review of health and social care needs in stroke survivors 6 weeks after hospital discharge. Clinical Medicine, Journal of the Royal College of Physicians of London, 14(2), 134-140. 
• Donnellan, C., & O'Neill, D. (2014). Baltes' SOC model of successful ageing as a potential framework for stroke rehabilitation. Disability and Rehabilitation, 36(5), 424-429. 
• Mawson, S., Nasr, N., Parker, J., Zheng, H., Davies, R., & Mountain, G. (2014). Developing a personalised self-management system for post stroke rehabilitation; utilising a user-centred design methodology. Disability and Rehabilitation: Assistive Technology, 9(6), 521-528. 
• Norris, M., Jones, F., Kilbride, C., & Victor, C. (2014). Exploring the experience of facilitating self-management with minority ethnic stroke survivors: A qualitative study of therapists' perceptions. Disability and Rehabilitation, 36(26), 2252-2261. 
• Park, M. G., & Ha, Y. (2014). Effectiveness of a self-management program using goal setting based on a g-ap for patients after a stroke. Journal of Korean Academy of Nursing, 44(5), 581-591. 
• Tielemans, N. S., Visser-Meily, J. M. A., Schepers, V. P. M., Post, M. W. M., Wade, D. T., & van Heugten, C. M. (2014). Study protocol of the Restore4Stroke self-management study: A multicenter randomized controlled trial in stroke patients and their partners. International Journal of Stroke, 9(6), 818-823.