Exploring stroke survivors' and physiotherapists' views of selfmanagement after stroke: a qualitative study in the UK

Objectives: Stroke is a sudden-onset condition with long-term consequences. Self-management could help address long-term consequences of stroke. Stroke survivors' and health professionals' views of selfmanagement may vary, limiting the successful introduction of self-management strategies. This paper explores stroke survivors' and physiotherapists' views of self-management, focusing on what selfmanagement means, and factors perceived to enable and hinder self-management after stroke, to draw out implications for policy, practice and future research. Design: Qualitative study using semistructured interviews and a thematic analysis approach. Setting: Stroke unit and community strokerehabilitation services in London, UK. Participants: 13 stroke survivors (8 men and 5 women; aged 53-89 years) admitted to a London stroke unit. 13 physiotherapists: 8 working in an inpatient stroke unit and 5 in community rehabilitation. Results: Key differences were evident in how selfmanagement was understood between these groups. Stroke survivors were unfamiliar with the term selfmanagement, but most could provide their own definition and relate to the term, and understood it as care of the self: ` doing things for yourself' and ` looking after yourself'. They did not recognise selfmanagement as part of their care, but valued therapists as encouraging experts in supporting their recovery after stroke. Physiotherapists commonly understood self-management as a process in which stroke survivors were expected to take an active role in their rehabilitation and manage their recovery and health, with different understandings of self-management among physiotherapists shaped by the context in which they worked. They reported that individual, social and organisational factors enable and hinder self-management after stroke, with individual and organisational barriers particularly evident in the early stages. Conclusions: If self-management support approaches are to be used, further work is required to explore the language and strategies used by professionals to support self-management, and the barriers to supporting self-management at different time points after stroke.