Abstract Background and aims Self-management is recommended in clinical guidelines/policy documents to promote recovery after stroke. Working relationships (therapeutic alliances) are one component of self-management. Alliance is not well understood in community stroke settings and there is no research in relation to stroke self-management. This PhD aimed to understand how alliance relates to self-management in community stroke services. Methods Three studies were conducted: a mixed-methods systematic review, and qualitative studies with healthcare professionals and stroke survivors. Results The review found no stroke rehabilitation studies. In other chronic conditions positive relationships were found between alliance and self-management. Eight factors influenced the relationship. Quantitative studies identified linear relationships, but qualitative studies suggested a dynamic relationship. In study two, healthcare professionals felt alliances were the foundation from which self-management skills develop. Delivery of self-management support is impacted by complicated power dynamics within the alliance and common misunderstandings of what self-management is. In study three, stroke survivors identified that the journey of self-management is long and complex. Person-centred alliances with healthcare professionals, focusing on the unique goals of the individual, are the heart of supported self-management. However, for stroke survivors, perceived changes to identity and how this impacts their sense of self is an important factor for self-management success. Conclusions The three studies suggest strong therapeutic alliances can influence self-management ability. However, different interpretations of what self-management is, may limit support strategies used by clinicians in community stroke rehabilitation. The discovery that disruptions to self-identity after stroke may hinder self-management success offers important clinical implications and directions for future research. Conflict of interest Dr Lauren Lucas, nothing to disclose. Prof Sarah Peters, nothing to disclose. Dr Sarah Cotterill, nothing to disclose. Prof Audrey Bowen, nothing to disclose.
Lucas et al. (Fri,) studied this question.