title: Self-Management Support Interventions for Stroke Survivors: A Systematic Meta-Review.
abstract: BACKGROUND
  There is considerable policy interest in promoting self-management in patients with long-term conditions, but it remains uncertain whether these interventions are effective in stroke patients.
  
  
  METHODS
  Systematic meta-review of the evidence for self-management support interventions with stroke survivors to inform provision of healthcare services.
  
  
  METHODS
  We searched MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, BNI, Database of Abstracts of Reviews for Effectiveness, and Cochrane Database of Systematic Reviews for systematic reviews of self-management support interventions for stroke survivors. Quality was assessed using the R-AMSTAR tool, and data extracted using a customised data extraction form. We undertook a narrative synthesis of the reviews' findings.
  
  
  RESULTS
  From 12,400 titles we selected 13 systematic reviews (published 2003-2012) representing 101 individual trials. Although the term 'self-management' was rarely used, key elements of self-management support such as goal setting, action planning, and problem solving were core components of therapy rehabilitation interventions. We found high quality evidence that supported self-management in the context of therapy rehabilitation delivered soon after the stroke event resulted in short-term (< 1 year) improvements in basic and extended activities of daily living, and a reduction in poor outcomes (dependence/death). There is some evidence that rehabilitation and problem solving interventions facilitated reintegration into the community.
  
  
  CONCLUSIONS
  Self-management terminology is rarely used in the context of stroke. However, therapy rehabilitation currently successfully delivers elements of self-management support to stroke survivors and their caregivers with improved outcomes. Future research should focus on managing the emotional, medical and social tasks of long-term survivorship.
authors.affiliation: Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Parke
authors.affiliation: Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
authors.forename: Eleni
authors.initials: E
authors.lastname: Epiphaniou
authors.affiliation: Centre for Technology Enabled Health Research (CTEHR), Coventry University, Coventry, United Kingdom.
authors.forename: Gemma
authors.initials: G
authors.lastname: Pearce
authors.affiliation: Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
authors.forename: Stephanie J C
authors.initials: SJ
authors.lastname: Taylor
authors.affiliation: Usher Institute of Medical Informatics and Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Griffiths
authors.affiliation: Nuffield Department of Primary Care Health Sciences, Medical Sciences division, University of Oxford, Oxford, United Kingdom.
authors.forename: Trish
authors.initials: T
authors.lastname: Greenhalgh
authors.affiliation: Usher Institute of Medical Informatics and Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
mesh_terms: D000203:Activities of Daily Living; D017028:Caregivers; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods; D012648:Self Care / Q000379:methods* / Q000592:standards*; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires; D017741:Survivors