Title: Investigating the feasibility of a group self-management programme after stroke
Funder: Department of Health and Social Care

Abstract: Background: Stroke is the commonest cause of long-term disability4. Improvements in survival after acute stroke5 and longer average life expectancy6 are likely to result in increasing numbers of chronic stroke survivors. Care of these individuals often stops after a brief period of community rehabilitation leaving many with unmet needs and feeling abandoned 7,8. Ongoing cuts to NHS funding will inevitably result in further reduction of stroke services, and demand for long-term stroke services will outweigh provision. One solution suggested in the National Clinical Guidelines is to promote self-management for stroke9. Self-management aims to help individuals take control of the medical, behavioural and emotional aspects of their condition. It has been explored in a range of chronic diseases and has successfully improved a number of patient outcome measures10,11. Bridges is a stroke-specific self-management programme (SMP) which can increase an individual s self-efficacy and locus of control (belief in one s ability to achieve goals and perceived control over one s condition)1. It is currently delivered on a one-to-one basis, but the optimum method of SMP delivery remains unclear. Non-stroke SMPs have been delivered in group settings with some success &ndash; they are potentially more cost effective and have the added bonus of improved social support. Before a fully powered randomised controlled trial to investigate the efficacy of a group stroke SMP can be conducted, there are still a number of questions about the feasibility of such an approach that need to be answered. Aim:The overall aim of this work therefore, is to investigate the feasibility of a group stroke SMP Plan of Investigation: Participants will be randomised to either the intervention group (group stroke SMP) or the control group (wait-list control group who later receive the intervention). The proposed work will be conducted in six phases over 36 months. At the end of each phase, two meetings will be held: The first with the University College Hospital London Clinical Research Network (UCLH-CRN) patient advisory group to receive feedback on how the study is being run. The second will be with the co-applicants to ensure milestones (see research timetable) have been met. Phase One &ndash; Gain ethical approval and design of the group SMP. Phase Two - 60 stroke survivors will be recruited from University College London Hospitals NHS Trust. Each participant will be randomised to condition in order to examine whether it is feasible to randomise participants to wait-list control groups in future RCTs of group stroke SMPs. Phase Three - Involves two focus groups which will investigate acceptability. One made up of stroke survivors and the other made up of carers. These groups will evaluate the programme design, acceptability and participant willingness to be randomised. Phase Four - The wait-list control group will receive the intervention, and two further focus groups will be run, again consisting or either stroke survivors or carers. Phase Five &ndash; Analysis of the data will be performed Phase Six &ndash; Dissemination and publication of the results Potential Risk: As there are no adverse events associated with either the one-to-one programme or other group SMPs reported in the literature this study is considered minimal risk. Potential Benefits: The findings of this work will impact delivery of long-term stroke services in the NHS in a number of ways. Firstly, if group stroke SMPs are successful there is potential for economic savings through both cost effective implementation of SMPs and reduction of health service utilisation. Secondly, the group stroke SMP has the potential to improve stroke survivor quality of life, self-efficacy and mood and the long-term support for stroke survivors by extending the stroke care pathway beyond community rehabilitation.

Lay abstract: Stroke is the commonest cause of disability in the world. In the UK alone, someone suffers a stroke every five minutes. In recent years, the number of people surviving a stroke has increased so that the number of people living with the long-term consequences of stroke is rising. The need for long-term stroke care will also rise and continue to outweigh our ability to provide it. Strategies to reduce the NHS s current &pound;8 billion a year stroke care bill are being looked at. Although long-term support services are already sparse, they have been further reduced in line with funding cuts. Stroke survivors only receive ongoing care for a short time after they are discharged home and subsequently, many feel abandoned and are left with needs that are unmet. Alternative ways to address these problems are desperately needed. One solution is to promote the idea of self-management after stroke. Self-management provides a set of techniques to help stroke survivors successfully deal with problematic aspects of their condition. Bridges is a one-to-one self-management programme which is just starting to be used within the NHS. Importantly, it can increase a person s belief in their own ability to cope. One-to-one delivery is expensive, but there is interest in whether self-management training in groups would be just as effective, cost less and provide additional benefits such as social support. Before we can conduct a properly designed clinical trial to investigate whether group self-management training works for stroke survivors, it is important to find out whether it is feasible &ndash; in other words whether it would be possible to conduct a larger clinical trial of self-management in groups and what the best design would be.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: STROKE