Clark, Ella V; (2018) The feasibility of a novel group self-management intervention for stroke. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Stroke survivors consistently report long term unmet needs. Unlike other chronic conditions stroke self-management programmes have been slow to emerge. Bridges self-management is a one-to one approach used by some UK NHS stroke services and aims to increase self-efficacy and confidence to manage long term needs post stroke. However, a one-to-one delivery does not facilitate peer support, which stroke survivors report as being valuable to the self-management process. In order to evaluate the potential for a one-one programme such as Bridges to be delivered in a group setting important parameters need to be explored, such as, acceptability, fidelity and outcome measure effect sizes. The MRC calls this type of research ‘feasibility’, and labels it an essential part of complex intervention development. The aim of this thesis was to explore the feasibility of delivering a one-to-one stroke self-management intervention (Bridges) in a group setting. Method: Feasibility was explored across three phases: (1) the development phase included patient involvement activities, stroke survivor interviews, and a systematic review to inform the design of a four-week self-management intervention, (2) the implementation phase monitored intervention delivery, 60 stroke survivors were randomised to the intervention or waitlist condition, (3) the evaluation phase used a mixed methods approach to explore acceptability and potential mechanisms of change as well as the effect of the intervention on mood, self-efficacy, quality of life and activities of daily living. Results: Overall it was feasible to adapt Bridges for group delivery. The intervention had high fidelity to the protocol. Recruitment occurred at a mean rate of 6.6 per month with a 21.667% drop out rate. The intervention was found to be acceptable to stroke survivors and carers. Potential mechanisms of change included vicarious learning and supported goal setting. At six-months post-baseline, outcomes had improved in favour of the intervention group. A number of recommendations were made to further develop the intervention, and for subsequent research on this topic. Conclusion: The thesis concludes that delivering a group self-management intervention for stroke may offer some benefits to stroke survivors and suggests research progress to a definitive trial.

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