Development and psychometric evaluation of a new patient -reported outcome measure for stroke self -management: The Southampton Stroke Self - Management Questionnaire (SSSMQ).

BACKGROUND: Self-management is important to the recovery and quality of life of people following stroke. Many interventions to support self-management following stroke have been developed, however to date no reliable and valid outcome measure exists to support their evaluation. This study outlines the development and preliminary investigation of the psychometric performance of a newly developed patient-reported outcome measure (PROM) of self-management competency following stroke; the Southampton Stroke Self-Management Questionnaire (SSSMQ). METHODS: A convenience sample of 87 people who had had a stroke completed responses to the SSSMQ, the Stroke Self-Efficacy Questionnaire and the Stroke Impact Scale. Scaling properties were assessed using Mokken Scale Analysis. Reliability and construct validity were assessed using intra-class correlation coefficient (ICC), Mokken and Cronbach's reliability coefficients and Spearman rank order correlations with relevant measures. RESULTS: Mokken scaling refined the SSSMQ to 28 scalable items. Internal consistency reliability (Mokken r = 0.89) and test-retest reliability (ICC = 0.928) were excellent. Hypotheses of expected correlations with additional measures held, demonstrating good evidence for construct validity. CONCLUSIONS: Early findings suggest the Southampton Stroke Self-Management Questionnaire is a reliable and valid scale of self-management competency. The SSSMQ represents a potentially valid PROM for the evaluation of self-management following stroke.

Stroke self-management: a focus group study to identify the factors influencing self-management following stroke.

BACKGROUND: Self-management refers to the strategies, decisions and activities individuals take to manage a long-term health condition. Self-management has potential importance for reducing both the personal and health service impact of illness. Stroke represents a significant health and social burden, however there is a lack of clarity about the factors that support successful self-management following stroke. OBJECTIVE: This study sought to investigate the factors which facilitate or hinder stroke self-management from the patients' perspective. DESIGN: Nested qualitative exploratory phase within a mixed-methods paradigm. Data were analysed thematically using Analytic Induction to guide development of themes. SETTING: Participants had experienced a stroke and were recruited from rural and urban community stroke support groups based in the South of England. METHOD: Five focus groups (n=28) using a semi-structured interview guide were conducted. Interviews were digitally recorded and transcribed. FINDINGS: The term 'self-management' was unfamiliar to participants. On further exploration, participants described how self-management activities were helped or hindered. Self-management was viewed as an important, unavoidable feature of life after stroke. Three key themes identified from the data affect stroke self-management: Individual capacity; support for self-management and self-management environment. People following stroke reported feeling ill-prepared to self-manage. The self-management support needs of patients following stroke are currently often unmet. CONCLUSION: Successful stroke self-management consists of features which may be modifiable at the individual level, in addition to the presence of external support and an environment which supports and facilitates people following stroke to self-manage. These findings extend current conceptualisations of stroke self-management.

Self-management: a systematic review of outcome measures adopted in self-management interventions for stroke.

PURPOSE: To systematically review the psychometric properties of outcome measures used in stroke self-management interventions (SMIs) to (1) inform researchers, clinicians and commissioners about the properties of the measures in use and (2) make recommendations for the future development of self-management measurement in stroke. METHODS: Electronic databases, government websites, generic internet search engines and hand searches of reference lists. Abstracts were selected against inclusion criteria and retrieved for appraisal and systematically scored, using the COSMIN checklist. RESULTS: Thirteen studies of stroke self-management originating from six countries were identified. Forty-three different measures (mean 5.08/study, SD 2.19) were adopted to evaluate self-SMIs. No studies measured self-management as a discreet concept. Six (46%) studies included untested measures. Eleven (85%) studies included at least one measure without reported reliability and validity in stroke populations. CONCLUSIONS: The use of outcome measures which are related, indirect or proxy indicators of self-management and that have questionable reliability and validity, contributes to an inability to sensitively evaluate the effectiveness of stroke self-SMIs. Further enquiry into how the concept of self-management in stroke operates, would help to clarify the nature and range of specific self-management activities to be targeted and aid the selection of existing appropriate measures or the development of new measures.

Paracetamol use in musculoskeletal pain: an audit of use and patient perceptions of paracetamol as an effective analgesic.

Musculoskeletal pain is a complex problem with often very detrimental consequences which affects a high proportion of the general population. Health care professionals, when prescribing for musculoskeletal pain, often overlook simple analgesia. Patient perceptions of analgesia may vary to those of health care professionals, and in part affect the use of simple analgesia for musculoskeletal pain. This paper describes an audit of paracetamol use and patient perceptions of paracetamol as an effective analgesic agent, in 113 patients attending a musculoskeletal pain outpatient clinic in a university teaching hospital. The audit has helped prompt the development of a multi-disciplinary strategy to achieve optimum management.