A staged approach to development, evaluation and implementation of integrated self-management support through the stroke pathway

South LondonStroke
Start Date: 1 Apr 2015 End Date: 1 Oct 2017

The Bridges Stroke Self-management Programme

The Bridges Stroke Self-management Programme(1) is designed to help stroke survivors take a leading role in their own rehabilitation.

‘Health and social care teams are taught ways to integrate different techniques to support self-management following stroke into their everyday practice,’ says Professor Fiona Jones who developed the Bridges Programme in collaboration with stroke survivors, their family members and stroke professionals. ‘The aim is to support people to take control and feel confident about their rehabilitation after discharge from hospital and therapy.’

The Bridges Programme uses a specially designed workbook that is given to stroke survivors. The workbook contains stories and experiences of stroke survivors of all ages and backgrounds, and strategies that they have found useful. Health and social care professionals support stroke survivors as they work through the book.

More than 80 stroke teams throughout the UK now use the Programme after attending Bridges training workshops.

'Bridges workshops encourage professionals to introduce the concept of self-management as soon as a patient arrives in hospital, and help them develop the skills they need to help people feel confident to manage in the longer term,’ says Professor Jones who is part of the CLAHRC South London stroke research team. She is based in the School of Rehabilitation Sciences in the Faculty of Health, Social Care and Education at Kingston University and St George's, University of London.

Ensuring Bridges is supportive of all stroke survivors 

This study aims to ensure that the Bridges Programme is equally supportive of stroke survivors who have cognitive, communication or mood difficulties. 

Recent research(2) has shown that people who have these difficulties after a stroke are less likely to access the Bridges Programme. 'This group of patients are less likely to gain access to any self-management programme,' says Professor Jones. 'Inequity and lack of access to self-management support for some groups, particularly those with more complex needs, has also been highlighted by the Health Foundation(3).'

Dr Jones wanted to find out why this is the case – and then revise the Bridges programme accordingly. 'Is it because Bridges is not accessible to those group of patients? Do health and social care professionals think these patients won't be right for self-management support? Or do health and social care professionals find it harder to support these patients and need a different set of skills?,' she says.

Gathering views of stroke survivors, their families and health professionals

The research team has gathered information from stroke survivors who have cognitive, communication or mood difficulties, their family members and the health and social care professionals who support them.

They reviewed the Bridges stroke workbook and discussed how it could be made more accessible for people with communication and cognitive problems. The workbook was also discussed with a local charity ‘Dyscover’, which was set up to provide long term support and advice to people with aphasia (a disability which affects the ability to speak, read, write and understand what’s being said, most commonly caused by stroke).

Their feedback has been used to adapt the current Bridges stroke workbook. Further work with these groups will also help develop self-management training for healthcare staff, so that they can support the needs of more people with cognitive and communication problems.

In addition, the research team has surveyed a sample of stroke teams who have attended Bridges workshops and a sample of stroke teams who do not currently use the programme to ask them what they think. 

Researcher Liz Livingstone is working on the project and the findings of the study will contribute towards her PhD, which is supported by the Faculty of Health, Social Care and Education at Kingston University London and St George's, University of London. The study will be completed in 2018.

For further information visit Bridges self-management

Professor Fiona Jones