title: Feasibility study of an integrated stroke self-management programme: a cluster-randomised controlled trial.
abstract: OBJECTIVE
  To test the feasibility of conducting a controlled trial into the effectiveness of a self-management programme integrated into stroke rehabilitation.
  
  
  METHODS
  A feasibility cluster-randomised design was utilised with stroke rehabilitation teams as units of randomisation.
  
  
  METHODS
  Community-based stroke rehabilitation teams in London.
  
  
  METHODS
  78 patients with a diagnosis of stroke requiring community based rehabilitation.
  
  
  METHODS
  The intervention consisted of an individualised approach to self-management based on self-efficacy. Clinicians were trained to integrate defined self-management principles into scheduled rehabilitation sessions, supported by a patient-held workbook.
  
  
  METHODS
  Patient measures of quality of life, mood, self-efficacy and functional capacity, and health and social care utilisation, were carried out by blinded assessors at baseline, 6 weeks and 12 weeks. Fidelity and acceptability of the delivery were evaluated by observation and interviews.
  
  
  RESULTS
  4 community stroke rehabilitation teams were recruited, and received a total of 317 stroke referrals over 14 months. Of these, 138 met trial eligibility criteria and 78 participants were finally recruited (56.5%). Demographic and baseline outcome measures were similar between intervention and control arms, with the exception of age. All outcome measures were feasible to use and clinical data at 12 weeks were completed for 66/78 participants (85%; 95% CI 75% to 92%). There was no significant difference in any of the outcomes between the arms of the trial, but measures of functional capacity and self-efficacy showed responsiveness to the intervention. Observation and interview data confirmed acceptability and fidelity of delivery according to predetermined criteria. Costs varied by site.
  
  
  CONCLUSIONS
  It was feasible to integrate a stroke self-management programme into community rehabilitation, using key principles. Some data were lost to follow-up, but overall results support the need for conducting further research in this area and provide data to support the design of a definitive trial.
  
  
  BACKGROUND
  ISRCTN42534180.
authors.affiliation: Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Jones
authors.affiliation: School of Economics, University of Surrey, Surrey, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Gage
authors.affiliation: School of Health Sciences, University of Nottingham, Nottingham, UK.
authors.forename: Avril
authors.initials: A
authors.lastname: Drummond
authors.affiliation: Division of Health and Ageing, Guy's & St Thomas NHS Foundation Trust, London, UK.
authors.forename: Ajay
authors.initials: A
authors.lastname: Bhalla
authors.affiliation: Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Grant
authors.affiliation: School of Health Sciences, Flinders University, Daw Park, South Australia, Australia.
authors.forename: Sheila
authors.initials: S
authors.lastname: Lennon
authors.affiliation: Division of Health & Social Care Research, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: McKevitt
authors.affiliation: Department of Psychology, Royal Holloway University of London, Surrey, UK.
authors.forename: Afsane
authors.initials: A
authors.lastname: Riazi
authors.affiliation: Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK School of Science and Health, University of Western Sydney, Sydney, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Liston
mesh_terms: D000339:Affect; D000368:Aged; D016000:Cluster Analysis; D019033:Delivery of Health Care, Integrated; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires
keywords: PUBLIC HEALTH; REHABILITATION MEDICINE