title: From dictatorship to a reluctant democracy: stroke therapists talking about self-management.
abstract: OBJECTIVE
  Self-management is being increasingly promoted within chronic conditions including stroke. Concerns have been raised regarding professional ownership of some programmes, yet little is known of the professional's experience. This paper aims to present the views of trained therapists about the utility of a specific self-management approach in stroke rehabilitation.
  
  
  METHODS
  Eleven stroke therapists trained in the self-management approach participated in semi-structured interviews. These were audio recorded, transcribed verbatim and analysed thematically.
  
  
  RESULTS
  Two overriding themes emerged. The first was the sense that in normal practice therapists act as "benign dictators", committed to help their patients, but most comfortable when they, the professional, are in control. Following the adoption of the self-management approach therapists challenged themselves to empower stroke survivors to take control of their own recovery. However, therapists had to confront many internal and external challenges in this transition of power resulting in the promotion of a somewhat "reluctant democracy".
  
  
  CONCLUSIONS
  This study illustrates that stroke therapists desire a more participatory approach to rehabilitation. However, obstacles challenged the successful delivery of this goal. If self-management is an appropriate model to develop in post stroke pathways, then serious consideration must be given to how and if these obstacles can be overcome.
  
  
  CONCLUSIONS
  Stroke therapists perceive that self-management is appropriate for encouraging ownership of rehabilitation post stroke. Numerous obstacles were identified as challenging the implementation of self-management post stroke. These included: professional models, practices and expectations; institutional demands and perceived wishes of stroke survivors. For self-management to be effectively implemented by stroke therapists, these obstacles must be considered and overcome. This should be as part of an integrated therapy service, rather than as an add-on.
authors.affiliation: Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel University , London , UK.
authors.forename: Meriel
authors.initials: M
authors.lastname: Norris
authors.forename: Cherry
authors.initials: C
authors.lastname: Kilbride
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D059825:Physical Therapists / Q000523:psychology*; D017410:Practice Guidelines as Topic; D024382:Professional Role; D011369:Professional-Patient Relations; D036301:Qualitative Research; D020127:Recovery of Function; D012648:Self Care / Q000379:methods* / Q000523:psychology; D000071939:Stroke Rehabilitation