Supported self-management in community stroke rehabilitation: what is it and how does it work? A protocol for a realist evaluation study

doi:10.1136/bmjopen-2021-055491

. 2022 Jan 20;12(1):e055491.

doi: 10.1136/bmjopen-2021-055491.

Supported self-management in community stroke rehabilitation: what is it and how does it work? A protocol for a realist evaluation study

Lisa Kidd¹, Julie Duncan Millar², Helen Mason³, Terry Quinn⁴, Katie I Gallacher⁵, Fiona Jones⁶, Rebecca J Fisher⁷, Therese Lebedis^{8

9}, Mark Barber^{9

10}, Katrina Brennan^{9

11}, Mark Smith^{9

12}

Affiliations

¹ School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK lisa.kidd@glasgow.ac.uk.
² School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.
³ School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
⁴ Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
⁵ Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
⁶ Centre for Health and Social Care Research, St Georges University of London, London, UK.
⁷ Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
⁸ NHS Grampian, Woodend Hospital, Aberdeen, UK.
⁹ Scottish Government Stroke Improvement Programme, Edinburgh, UK.
¹⁰ Lanarkshire Acute Hospitals NHS Trust, Bothwell, South Lanarkshire, UK.
¹¹ NHS Lanarkshire, Coathill Hospital, Coatbridge, UK.
¹² NHS Lothian, Leith Community Treatment Centre, Leith, UK.

PMID: 35058265
PMCID: PMC8783824
DOI: 10.1136/bmjopen-2021-055491

Supported self-management in community stroke rehabilitation: what is it and how does it work? A protocol for a realist evaluation study

Lisa Kidd et al. BMJ Open. 2022.

. 2022 Jan 20;12(1):e055491.

doi: 10.1136/bmjopen-2021-055491.

Authors

Affiliations

¹ School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK lisa.kidd@glasgow.ac.uk.
² School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.
³ School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
⁴ Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
⁵ Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
⁶ Centre for Health and Social Care Research, St Georges University of London, London, UK.
⁷ Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
⁸ NHS Grampian, Woodend Hospital, Aberdeen, UK.
⁹ Scottish Government Stroke Improvement Programme, Edinburgh, UK.
¹⁰ Lanarkshire Acute Hospitals NHS Trust, Bothwell, South Lanarkshire, UK.
¹¹ NHS Lanarkshire, Coathill Hospital, Coatbridge, UK.
¹² NHS Lothian, Leith Community Treatment Centre, Leith, UK.

PMID: 35058265
PMCID: PMC8783824
DOI: 10.1136/bmjopen-2021-055491

Abstract

Introduction: A growing evidence base demonstrates the effectiveness of supported self-management in stroke for stroke survivors and their families. However, there is significant variation in its implementation in community stroke care and little understanding about how supported self-management works and is delivered across different settings, models used and contexts of community stroke rehabilitation.

Methods and analysis: Using a mixed method, realist approach across two phases, this protocol describes a study on community-based supported self-management. The aim is to identify the mechanisms and outcomes of supported self-management in stroke and to understand how supported self-management is implemented in different contexts of community stroke rehabilitation. Phase 1 involves (1) a realist synthesis, (2) a scoping and mapping of current community rehabilitation settings and (3) a Q-methodology study to develop initial programme theories about how community-based supported self-management works, for whom and in what contexts. Phase 2 involves realist informed interviews/focus groups with stroke survivors, community rehabilitation practitioners and team managers from across Scotland to test and refine programme theories and an explanatory model for how supported self-management works across different contexts of community-based stroke rehabilitation.

Ethics and dissemination: Ethical approval and R&D approvals have been granted from East of Scotland Research Ethics Committee (REC reference number: 19/ES/0055) and participating NHS boards. An understanding of how, for whom and in what contexts community-based supported self-management works will help to strengthen its delivery in practice. Such an understanding will enable the design of context-specific recommendations for policy and practice that genuinely reflect the challenges in implementing supported self-management in community stroke care. Results will be disseminated to clinical partners working in community stroke rehabilitation, stroke survivors and families and to policymakers and third sector partners involved in the provision of long-term support for people affected by stroke.

Prospero registration number: CRD42020166208.

Keywords: organisation of health services; rehabilitation medicine; stroke.

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Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Outline of the stages of the study. SSM; Supported Self-Management.

See this image and copyright information in PMC

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References

1. The Stroke Association . State of the nation. London, UK, 2018.
1. Gallacher KI, Batty GD, McLean G, et al. . Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burden. BMC Med 2014;12:151. 10.1186/s12916-014-0151-0 - DOI - PMC - PubMed
1. Ayerbe L, Ayis S, Crichton S, et al. . The long-term outcomes of depression up to 10 years after stroke; the South London stroke register. J Neurol Neurosurg Psych 2014;85:514–21. 10.1136/jnnp-2013-306448 - DOI - PubMed
1. World Health Organisation . Innovative care for chronic conditions: building blocks for action Geneva report. World Health Organisation, 2002.
1. Goodwin N, Curry N, Naylor C. Managing long-term conditions. London, UK: Kings Fund, 2010.

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[1] The Stroke Association . State of the nation. London, UK, 2018.

[2] The Stroke Association . State of the nation. London, UK, 2018.

[3] Gallacher KI, Batty GD, McLean G, et al. . Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burden. BMC Med 2014;12:151. 10.1186/s12916-014-0151-0 - DOI - PMC - PubMed

[4] Gallacher KI, Batty GD, McLean G, et al. . Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burden. BMC Med 2014;12:151. 10.1186/s12916-014-0151-0 - DOI - PMC - PubMed

[5] Ayerbe L, Ayis S, Crichton S, et al. . The long-term outcomes of depression up to 10 years after stroke; the South London stroke register. J Neurol Neurosurg Psych 2014;85:514–21. 10.1136/jnnp-2013-306448 - DOI - PubMed

[6] Ayerbe L, Ayis S, Crichton S, et al. . The long-term outcomes of depression up to 10 years after stroke; the South London stroke register. J Neurol Neurosurg Psych 2014;85:514–21. 10.1136/jnnp-2013-306448 - DOI - PubMed

[7] World Health Organisation . Innovative care for chronic conditions: building blocks for action Geneva report. World Health Organisation, 2002.

[8] World Health Organisation . Innovative care for chronic conditions: building blocks for action Geneva report. World Health Organisation, 2002.

[9] Goodwin N, Curry N, Naylor C. Managing long-term conditions. London, UK: Kings Fund, 2010.

[10] Goodwin N, Curry N, Naylor C. Managing long-term conditions. London, UK: Kings Fund, 2010.

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Supported self-management in community stroke rehabilitation: what is it and how does it work? A protocol for a realist evaluation study

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Supported self-management in community stroke rehabilitation: what is it and how does it work? A protocol for a realist evaluation study

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