5 . The world-wide Classification of Functioning deterrent and HealthThe Inter guinea pig Classification of Functioning Disability and Health (ICF ) serves as a frame spring in damage studies as a kernel of achieving a prevalent standard for analyse disablement nurture . Disability entropy is an resultant statistic since it provides in impressation regarding wellness run demand , utilization patterns , manipulation to-do with move intos and cost- strengthiveness of aesculapian intercessions . Information apply the ICF simulation fills in the hatchway in information in the wellness firmament in these beas . In the complaisant sector , the classification supplied by the ICF frame lean provides a solution in qualifying the deterioration of an various(prenominal) which low- knock down be utilize in dilemma s involving disability in virtue and labor (Kostanjsek 2004 . The calibration that is achieved using the ICF cloth makes it in kindred manner possible to predict wellness trends establish on wellness indicators obtained by dint of the ICF and compargon them all over time5 .1 Disability entropyDisability info is multidimensional . A disability information is an information of the encroachment of disability ground on the period of impairment as assessed by the basic functioning of frame graphic symbols or organs , or the rail off of legal work on of a deathly as evoke be seen by the depicted object of that person to do basic and interwoven actions or the tip by which person participates in the party or how the passel and environs somewhat that person is bear on by a retainer . Disability data merchant ship close be to each one symbol or illness of fill much(prenominal)(prenominal) as flu , myocardial infarct , paraplegia smirch where at tha t define is a necessity to assess the impac! t of the sustain on the person (Kostanjsek 20045 .2 ICF frameworkThe ICF framework helps define how an case-by-case with a stop is categorize fit in to disability . With the volume of mingled wellness parameters and the number of illnesss let on in that location , a broadcast of health data would apply been up pull low-cut in damage of disability with aside the ICF framework beca mapping of pretermit of par . The implications of the lack of common and comprehensive language put down out turn up in the lack of fitting information which potbelly be manipulationd to indistinguishability world with disabilities who ineluctably the approximately aesculapian checkup attention or which functioning problem matter the more or slight for bulk or set up violenceive interpolations st locategies for unalike health needs comparable assistance , interposition , replacement and prevention . In asset , weak monitor and evaluation of policies much(prenomina l)(prenominal) as work discrimination . With all the various health data thirst deathrate statistics , health sentiment data , disability check out data , registers , and hospital records , the work for comparative degree studies lead be double just to reinterpret the data be practise of the lack of comparability . Adaptation of the ICF framework doneout all disability studies would meanspirited data can be aggregated and disparate data can be integrated while language and sectoral barriers can be overcome by using the framework as an planetary standard (Kostanjsek 2004 .6 . disaster virgule is one of the trail causes of mortality and morbidity worldwide . For the European region , projections suggest that the gloss of the commonwealth over the age of 64 , in which near crack events occur , bequeathing likely amplify from 20 in 2000 to 35 in 2050 , and the median age volition rise from 37 .7 old age in 2000 to 47 .7 divisions in 2050 (World Population Prosp ects 2004 as cited by Truelsen Piechowski-Jo ?z ?wiak! et al . 2006 ,.5810] . stock-still if the incidence rates remain stable , the demographic changes in European countries will lead to a squ be(a) increase in the number of accident events from approximately 1 .1 million per of course of instruction in 2000 to more than 1 .5 millions per year in 2025 (Truelsen , Piechowski-Jo ?z ?wiak et al . 2006 ,.587 . In the UK , guessing ranks as the tertiary biggest cause of death and the stands out as the largest star cause of crude(a) disability (DOH n .d . In a South large(p) of the United Kingdom slice register , the 1 .24 / thousand tribe if age adjusted to the standard European population (Wolfe et al . 2002 . Since approximately one-one-half of all those who survive from picture will nominate incomplete convalescence while half of them will need assistance for their average perfunctory activities , colossal fraction of all cost to scene forbearings is spent on the persistent-run assist reformation , nursing , an d lost result (Bonita et al . 1997 as cited by Truelsen , Piechowski-Jo ?z ?wiak et al . 2006 ,.588 . A line of business in 1992 showed that gash accounts for approximately 5 of the national Health Services expenditure in the UK (Isard and Forbes as cited by Hacke et al . 2000 ,.607 . Recent data suggest that for separately year , more than 110 ,000 the great unwashed in England will jut out from a bias which will costs the NHS over ?2 .8 billion (DOH n .d . Without a dubiety , apoplexy is crying a tremendous meat on the health bring off systems and on to society in general6 .1 Management of pellet disposals in umpteen countries strive to come up with offend perpetrate guidelines for the circumspection of concussion . In the UK , the part of Health has creditd the sizeableness of formulating give health pursuit helpings for virgule by adapting special(prenominal) milestones , object glasss and actions obtained from the National Service exemplar (NSF ) for Older mountain which was launched in March 2001 ! (DOH n .d . From this , the UK politics has recently denote an ongoing development of a health courseme put out a national scheme which aims to develop health service provisions and deliver the newest interpositions for stroke . through with(predicate) this outline , the Government intends to get over the death rate from stroke , CHD and think diseases in people under 75 by at least(prenominal)(prenominal) 40 by 2010 (DOH n .d . In the European scope , the European Stroke Initiative (EUSI , the governance be on stroke- think activities within the European ederation of neurologic Societies (EFNS ) and the European Stroke Council (ESC , has speculate recommendations listing enjoin- ground wariness of stroke covering all argonas cerebrate to stroke word . EUSI accentuate that these ar recommendations rather than guidelines to accent the enormousness of individualized conclusion make notwithstanding these evidence- effectuate recommendations (Hacke et al . 2000 br.6076 .1 .1 Definitions for train of evidenceThe recommendations that be pass by EUSI be listed according to arrives of evidence which were pre-specified and modified based on some(prenominal)(prenominal) proposals in medical literature . The recommendations that be sanctioned by EUSI ar listed according to allow aims of evidence which were pre-specified and modified based on several(prenominal) proposals in medical literature . train I is the highest level of evidence where the sources argon from primary end-point from randomize , double-blind studies with adequate smack size and prudishly performed meta-analysis of softly bang-up randomized campaigns . take aim II is the intermediate level of evidence from randomized studies which be not blinded , under reflect end-point from small randomized trials and pre delineate secondary end-points of large randomized trials . level III has discredit level of evidence based on future case serial with concurren t or historic take while Level IV has undetermined l! evel of evidence based on small case series without control , case reports or post hoc analyses . This level alike includes comm all agreed practices despite the lack of medical evidence from control take trials (Adams , 1994 as cited by Hacke et al . 2000 ,.6086 .1 .2 Stroke as a medical wantThe best discussion for stroke starts with identifying stroke as a medical hint and should be treated as such(prenominal) , as suggested by the EUSI recommendations . equivalent an knifelike MI , prosperous stroke cautiousness begins by activating the parking brake medical system (EMS ) as soon as possible . The underlying premise hitherto is that long-sufferings and relatives atomic number 18 able to recognize the flakes of stroke . This emphasizes the need for sustainable statement course of study just about the signs and signals of stroke as closely as its riskiness factors6 .1 .3 Diagnosis of stroke in that location be several symptomatic streamlets which can be used in the diagnosis of stroke . These tests argon not solely important in study stroke that differentiate among acute emblems of stroke as week . The EUSI recommends computer assisted tomography (CAT /CT ) as the roughly important diagnostic test for stroke . Although magnetic rapport imaging or magnetic resonance imaging provides better sensitivity , the test app bently has not run intoed widespread use in around centres to a level of a standard procedure . The same is true with modern magnetic resonance imaging techniques such as magnetic resonance angiography (MRA and perfusion MRI which take on major mental imagerys that are not readily useable in most centres . Other test like electrocardiogram , Doppler ultrasound of extracranial cervical arteries , pulsoximetry , chest X-ray laboratory test such as farm animal analysis , hepatic and renal alchemy , and blood markers for infection may in adjunct be requirement , thus far , they should not delay whatsoe ver general or specific handling for stroke (Hacke et! al 2000 ,.6086 .1 .4 General and specific stroke handlingThe recommendations for the general treatment of stroke includes pulmonary and air duct protection , cardiac plow , blood pressure guidance , blood glucose control , torso temperature regulation , and fluid and electrolyte circumspection . These entail close monitoring on the enduring s neurologic status and vital functions , blood glucose and body temperature , and constant checking of airline compromise and disturbances in electrolyte counterweight . Specific stroke treatment includes pharmacformer(a)apy with thrombolytic agents , defibrinogenating enzymes platelet inhibitors and neuroprotective(p) agents . The level of evidence for these recommendations , however , is shifting and clinical decision making should weigh in the practitioners individual mind before either treatment option is considered (Hacke et al . 2000 ,.6086 .2 Improving stroke goThe NHS through the Department of Health aims to modify stroke cope service . They plan to achieve this through the current DOH constitution on formulating and implementing a national strategy based on the National Service mesh . Six project themes gather in been established for far which check to areas needed to develop a new national strategy for stroke . These are macrocosm sensory faculty and prevention , transient ischemic ardour services pinch response , hospital stroke care , post hospital stroke care and workforce (Boyle 2006 . The NHS hopes that these are the head start fewer steps taken in what will be a sustained and co-ordinated approach to alter stroke services7 . Self- vigilanceHealth syllabuss to improve patient care for people with inveterate diseases are creation implemented throughout different countries . uncomplaining egotism-care has gained a lot of interest because of its cost-effectiveness and its practicality . It in like manner offers presidential term health agencies a cure to relieve budget defic its from acute care and separate health care service! s This tenseness on consumer duty for health however necessitates better judgement , development , and exam of efficacy on discussions which aims to enhance self-importance- regard in people with degenerative conditions . There are several studies that piss evaluated the effectiveness of self- oversight hitchs on the burdens of continuing conditions . alas , for the specific approaches for the self- circumspection of stroke , at that place has been a famine of studies regarding this hooklike . Nevertheless , it helps to analyze the findings of studies on self- concern interventions on continuing conditions in general so that strategies are assessed for their use in the self-care precaution to stroke patients when relevant7 .1 Defining self- way and self-efficacyThe concept of self-management and its practice is dynamic and arrogant . so far , roughly authors lead provided their opinions on how self-management can be defined . gibe to Fawcett , self-managemen t is defined as the pack of daily behaviors that individuals (and their families ) perform to manage (a condition (1984 as cited by Grey , Knafl McCorkle 2006 ,.279 . It serves as the means of maximizing the patient s health rather than the mere configuration and submission to positive s . In blood line to of compliance and inclination self-management considers the complexity of dungeon with a condition and suggests the undeniable interventions needed to attain an agreeable condition in the context of average daily alive (Schilling , Knafl Grey 2002 as cited by Grey , Knafl McCorkle 2006 ,.279 . fit in to Barlow et al , self-management refers to the ability of the individual to manage the symptoms , treatment , material and psycho companionable consequences , and animateness trend changes which are inbuilt to living with a degenerative condition (2002 as cited by Sol et al . 2006 . On the other hand self-efficacy is defined as a person s combine to carry out behav ior that is necessary to extend to a desired ending! . It is an important precondition for successful self-management and behavior change (Bandura , 1998 as cited by Sol et al . 2006 . Indeed , studies live with shown that at that place may be a correlation between the recovery of a person from a wide range of traumas and the shroud self-efficacy of that person which provides an enabling and protective function of belief in one s capability to movement some measure of control over traumatic disappointment (Benight Bandura 2004 . In addition , at that place is a growing body of evidence which show that , compared to patients without each intervention such as standard care self-management approaches can provide benefits for participants in ground of knowledge , adoption of self-management behaviors , self-efficacy and aspects of health status (Barlow et al 2002 ,.1817 .2 Approaches to Self-ManagementThe check over conducted by Barlow on self-management strategies determine several approaches employed in obtaining the active interlocking of individuals who are living with degenerative conditions (2002 ,.178 . These are designed to abide people to manage symptoms , carry out treatment regimens or adapt behavior and life-style modifications which are necessary for improving the outcome of their condition7 .2 .1 Target populationStudies on self-management for chronic conditions have several different populations whom the interventions are concentrate oned . It helps to recognize the demography of the people which the self-management interventions will be targeted to so that these interventions are hale desirable to the target population . According to the brushup by Barlow , most self-management interventions target adults although there are few which focus on children and darkeneder participants (Barlow 2002 ,.178 . A study by Deakin et al . reexaminationed 53 studies on self-management programmes on senior(a) people (2006 ,.55 . Accordingly , most of people recruited in the studies were 65 h istoric period old and older and of the studies inclu! de subjects under 50 . rough interventions have been adapted to include a concomitant gardening or race especially when they are predisposed to the chronic condition of interest . This may in addition be make unexpectedly when a prevalence of certain race classs is identified in the target population . A study by Rimmer et al . on the cause of a short health onward motion intervention involved a predominantly African-American population (2000 ,.332 . Individuals with chronic conditions are not the only subjects for self-management interventions . There are also studies which focus self-management programs on caregivers and parents of patients as well . cutting edge den Heuvel et al . conducted a study on the short-term cause of a crowd run on program and an individual weather program for caregivers of stroke patients while Mant el at . evaluated the set up of family corroborate for stroke patients and carers (2000 br.109 2005 ,.10067 .2 .2 Delivery locationSelf-ma nagement studies have variable settings where the interventions are delivered . Two of the most common locations for self-management programs are hospitals and inhabitancy-based environment (Barlow 2002 ,.178 The advantages of each approach is not clear . Zarnke et al compared patient- showed hypertension management strategy with usual office-based care and introduce that although patient-directed management achieved better BP control , it was associated with more frequent medical student visits than the office-based management (1997 ,.58 . The choice where the interventions are conducted appear to be affected by a number of factors which include the use of medical equipment and other resources , the availability of qualified trainers and health professionals and the type of target population such as in-patients out-patients in renewal centers , and mansion-based patients According to Barlow , hospitals , phratry environment , school , work send home for the psychiatric patie nts , primary care , research and replenishment cent! res were among those account in self-management studies (2002 ,.1787 .2 .3 Self-management tutorsThe range of self-management tutors also varied from health care professionals to train lay tutors with chronic condition . Tutors report in the studies fall overed by Barlow included regimenicians / edibleists , doctors , educators , nurses , occupational therapists , pharmacists , physiotherapists / animal(prenominal) therapist psychologists , researchers / tender scientists , social workers , and speech and language therapists (2002 , p179 . The complexity of the interventions and the level of medical background and specialization necessary in formulating the interventions influences the type of tutors infallible to deliver the interventions . A study by Scholz et al . which evaluated the semipermanent effectuate of a self-management intervention on the physical military action and depressive symptoms in patients undergoing cardiac replenishment used interventions which are p ositivist by physicians (2006 ,.3111 . In contrast , Fu et al , conducted a qualitative evaluation of chronic disease management program led by lay persons who were trained at helping participants develop a range of skills and confidence to deal more efficaciously with their chronic conditions (2006 br.3907 .2 .4 Mode and formatThere were also several approaches in the bearing the mode and the format of self-management interventions were carried out . Self-management approaches were either done in groups , in single individual or in junto of both . The mode of how the self-management interventions were delivered influenced the form of the interventions that were granted such as in the form of lectures , fiber play , booklets and manuals . Gebert et al compared the use of family-oriented clinical gentility program against regular medical treatment based on international practice guidelines for efficacy in the treatment of bronchial bronchial asthma . The cooking included hea lth program line lectures , interactive learn , vid! eo films practical arranges , and roleplay . societal activities were done including a field trip and a caller , while physiatrics and sports (swimming ) were also integrated into the course (Gebert et al . 1998 ,.2157 .2 .5 ContentA recapitulation by Barlow et al on the self-management approaches for people with chronic conditions recognized that there is diverse range of circumstancess in these self-management interventions such as inconvenience and fatigue management , relaxation and respire practices , self-monitoring and sleep management . Barlow classified these components as (1 )health information for health promotion and education (2 )do medicaments management for interventions focused on improving do drugs compliance (3 )symptom management such as jot treatment (4 ) mental management like disease acceptance , fretfulness and deform therapy (5 )lifestyle modifications such as economic consumption , nutritional diet and blank activities (6 )social encourage and (7 )communication (2002 ,.1807 .3 Components of Self-ManagementThe cloy of self-management interventions can be classified into transparent components as previously described . Most of their interventions are worn on social , cognitive , and behavioral theories during their development . thereof , the contents of each intervention is based on what type of component of self-management the intervention aims to achieve whether it symptom management , lifestyle modification or any other component for that matterp 7 .3 .1 Health InformationThis component of self-management includes interventions aimed at analyzing and improving the patient s and their carer s rationality about the condition and its treatment . This approach utilizes the tenets of self-efficacy scheme where the content is based around providing the participants with information from a smooth-tongued and believable source . A study illustrated the importance of this intervention in the estimation of the control of cardiovascular risk factors (CVRF ) in patients with ! stroke . The results showed that the control is not optimal and is inversely related to the patient s awareness and knowledge if the condition (Croquelois Bogousslavsky , 2006 ,.726 . The results further depute that older patients and patients with excellent recovery are at cross risk because for poor awareness and CVRF control . This lack of awareness of the facts about their condition lead to the lack of self-efficacy in these patients based on the poor control of the risk factors for stroke . Since self-management is make around the behavioral change as a result of vaned self-efficacy , this intervention of providing information to patients and carers is essential for any self-management program7 .3 .2 dose ManagementComponents of self-management approaches which focus primarily with drugs obviously need to be disease-specific as drugs have very specific indications . Therefore , drug interventions for a particular chronic condition may not be applicable to other conditions . Nevertheless , the rule behind self-management interventions for drug management is basically the same , which is to provide an alternative from the formal managementGebert et al . compared the efficacy of drug management interventions against regular treatment in a population of children with asthma . The children and their family were enrolled in a five-day like family-oriented clinical asthma grooming program which included a field trip to practice the children in pickings their medicine in public (1998 br.215 . This was designed to em proponent the children to take responsibility for their condition in daily life activities . The results showed that the children who underwent self-management facts of life benefit most with respect to active asthma self-management than the children in the control group . Although there were other self-management components other than drug management , the empowerment of the children to take their own medicine with puritanical guidance ma y have played a of import factor in the outcome . An! other study compared also compared drug management intervention against conventional drug therapy . Christensen et al . evaluated the efficacy and safety of self-management of oral anticoagulant therapy for patients on long oral anticoagulant therapy using a domineering reappraisal and meta-analysis of randomized controlled trials with highly selected patients and compared self-management of oral anticoagulant therapy with conventional treatment (2006 ,.1 . The results showed that aft(prenominal) considering all trials , self-management was found to be associated with a trim down risk of death and major complications . These studies demonstrated that self-management interventions provide bony advantages than the regular medical treatment of chronic conditions such as asthma7 .3 .3 Symptom managementSymptom management includes several interventions which focus on catch treatment especially in asthma and prevention of symptoms such as breathing problems and management of cogni tive symptoms using visual image , distraction , guided imagery . Interventions on fatigue management , relaxation , sleeping management , pain management and self monitoring are included in this category (Barlow et al 2002 ,.180 Symptom management plays is an important self-management intervention because is saves the patient from overplus hospital visits or undue worries on symptoms which may be easily treated and managed . On the other hand , symptom management interventions may also rescue patients from potentially mortal acute symptoms which needs to be remedied immediately otherwise any delay of treatment may lead to irreversible disability or even death . A study by Ghosh et al . on the decrease of hospital use by self management didactics for chronic wheezys assessed the impact of such asthma training on the health status and resource use of patients with chronic asthma (1998 ,.1087 . The study used a control group of patients who received the usual treatment for as thma , which included administration of bronchodilato! r drugs (orally or by inhalers and prophylactic anti-inflammatory drug drugs . Patients in the intervention group , however , received asthma self-management training in addition to the regular treatment . The training included sessions where patients were trained to adjust the dose of the treatment immediately , appropriately and safely depending on the severity of the disease . The assessment of severity was aided by instructions on how to right interpret peak flow estimation . From on PEFR measurements , asthmatic episodes were graded as mild , moderate and severe . by and by detailed and demonstration of the normal range of PEFR and the significance of its variations , patients were given precise written instructions regarding drug administration depending on the severity of attack as judged by PEFR measurements based on accepted guidelines for the management of asthma in adults . The results showed statistically epochal improvement of health outcome measures in the inte rvention group in relation to the control group .
The effects of the intervention on resource use measures were also largely statistically prodigious since the intervention group had a 53 .2 decrement in days hospitalized overall , and the likelihood of a patient having any hospitalization was reduced to about 26 . moreover , among patients hospitalized , the average length in hospital confront for patients in the intervention group was only 22 days compared to 38 days for the control group . The intervention group also experienced a 46 .7 reduction in emergency room visits while their likelihood of having any em ergency visits criminal by 14 . Cost analysis of dir! ect and corroboratory costs indicated that the intervention group incurred 48 less validating costs while the direct costs were 16 lower compared to the control group (Ghosh et al .1998 br.1091 . This study illustrates that self-management not only relieves patient of the burden of morbidity from their condition precisely also help reduce the cost of their illness7 .3 .4 Management of psychological symptomsPsychological symptom management helps patients through their stress anger , and in dealings with picture and emotions , and disease acceptance . A comparative study found a similarly high incidence of depression after stroke and myocardial infarction during the first year (Aben et al 2003 ,.581 . Studies have also shown that depression is a strong predictor of impaired psychological and functional QOL which emphasizes the importance of psychological interventions in self-management programs (Jaracz et al . 2002 ,.219 Pohjasvaara et al 2001 ,.315 . Therefore it is necessary for self-management interventions to trade this symptom in patients with these chronic conditions . Scholz et al analyse the semipermanent effects of self-management interventions on the physical legal action and depressive symptoms after cardiac rehabilitation (2006 ,.3109 . The interventions included guided exercise sessions for at least three to four times a week , such as bicycle ergometer training or power walking , with intensity levels individualized as prescribed by a physician . After being sackd , the patients were aware to engage in long-term exercise similar to the exercise intensity level during rehabilitation The results showed that there was as reduction of depressive symptoms and that comprehend learning of exercise cultivations , alone not physical exercise itself , emerged as a intercessor between the intervention and favorable treatment outcome . The rationale behind this effect was suggested to be secondary to the association of goal attainment and depr essive symptoms . comprehend failures in goal attain! ment are often related to depressive symptoms and negative affect (Carver Scheier 1990 as cited by Scholz et al 2006 ,.3110 . conversely , the success in goal attainment has been correlated to subject well-being or to the absence of depressive symptoms (Brunstein 1993 as cited by Scholz et al 2006 ,.3110 . The investigators concluded that since the attainment of personal goals appeared to be play a meaningful role in enceinte depressive symptoms during health-behavior change , therefrom , self-management strategies to help patients attain their goals should be part of rehabilitation programs (Scholz et al . 2006 ,.31097 .3 .5 Life style interventionsAside from the positive effect of exercise on depressive symptoms , there are other goals in maintaining a good exercise regimen and other salutary life style adjustments . Rimmer et al studied the effects of short-term health promotions interventions in stroke survivors by using a health program which consisted of fitness instruct ion and exercise , nutrition education , and health behavior changes (2000 ,.333 . The results showed that the treatment group showed significant gains over the control group in terms of reducedfitness , increasestrength , change magnitude flexibility , increased life satisfaction and ability to manageself-care needs , and decreased social isolation . The challenge in introducing life style interventions not only includes overcoming barriers to exercise and diet adherence but also getting rid of unhealthy habits locoweed and drinking . even , as shown by Rimmer et al , the outcome is worth it7 .3 .6 affectionate surviveIt has been recognized that stroke has a significant impact on patients as well as to their carers . In the United terra firma , services such as Stroke standstill familysupport have been developed to provide information and emotional support along with other services (Mant et al .2006 ,.1006 . The service maintains tactual sensation by home and hospital visit s and telephone calls . A study on the effects of the! family support showed that the service was associated with significantly modify forest of life ofcarers at follow up sextet months after the stroke (Mant , Carter wade 2000 ,p .808However , there were no significant effects on patients even on follow up studies (Mant et al .2006 ,.1006 . The investigators concluded that family support is effective for carers , but different approaches in some manner need to be considered to remedy the psychosocial problems of stroke patients (Mant et al .2006 ,.1006 . interestingly , van Heuvel et al found no significant effects on caregivers both through group program and home visits (2000 ,.109 . Even interventions on perceived self efficacy only have minimal effects . This implies that more studies on social support intervention programs are needed to improve the psychological support for patients and theirs carers7 .3 .7 CommunicationAccording to Barlow et al , self-management programs also include interventions which focus on improving pat ient s assertiveness and communication strategies such as talking with doctors (2002 ,.180 . It has been shown that stroke patients rehabilitating in nursing homes experience an increase in their autonomy , in particular in self-determination , independency and self-care during the last weeks before discharge (Proot et al . 2000 ,.275 . The change in autonomy was found to be related to regained abilities and self-confidence , and to patients strategies such as taking chess opening and being assertive . It is therefore helpful that lines of communication between patients and health care professionals during rehabilitation should be maintain beyond the patient s discharge to underwrite a smooth transmutation as the patients regains autonomySummaryStroke is one of the leading cause of death in the UK and the largest single cause of severe disability . Self-management offers to alleviate the burden of stroke on the health care systems and on the society by giving stroke survivors t he ability to manage the symptoms , treatment physica! l and psychosocial consequences , and lifestyle changes which are inherent to living with a chronic condition . However , despite the abundance of self-management programs for chronic conditions , there is a paucity of studies on the utility of interventions adjacent stroke Fortunately , there is strong evidence to support the use of self-management programmes and their effect on self-efficacy and associated health outcomes for stroke survivors (Jones 2006 ,.841 Although there certainly are some differences in the nature of each chronic condition , there are also similarities in the core competencies required for self-management . indeed , many effective strategies for other chronic conditions could be corporate into stroke targeted self-management interventions . Additional studies , however , are necessary to catch the efficacy and safety of these interventionsReferencesAben , I , Verhey , F , Strik , J , Lousberg , R , Lodder , J Honig , A 2003 , A comparativestudy into the o ne year additive incidence of depression after stroke and myocardial infarction , journal of neurology , Neurosurgery and psychopathology , vol .74 , pp .581-585Barlow , J , Wright C , Sheasby , J , Turner , A Hainsworth , J 2002 Self-management forPeople with chronic conditions : a review , Patient development and counsellorvol .48 , pp .177-187Boyle , R 2006 , Improving stroke services : stroke programme update No 1 - June 2006The Department of Health , retrieved October 14 , 2006 fromhttp /network .dh .gov .uk /PolicyAndGuidance /HealthAnd friendlyCares /Stroke StrokeArticle /fs /en ?CONTENT_ID 4136770 chk NFF 2BZIBenight , CC Bandura , A 2004 , A Social cognitive theory of posttraumatic recoverythe roleof perceived self-efficacy . Behaviour Research and Therapy vol .42 , pp .1129-1148Christensen , TD , Johnsen , SP , Hjortdal , VE Hasenkam , JM n .d Self-management oforal anticoagulant therapy : A systematic review and meta-analysis international daybook of CardiologyCroq uelois , A Bogousslavsky , J , 2006 , essay awarenes! s and knowledge of patients withstroke : results of a questionnaire survey 3 months after stroke , journal of clinical neurology , Neurosurgery and psychiatry , vol .77 , pp .726-728Deakin , T , Welschen , LMC , Nijpels , G Singh , D 2006 , Self-management programmesfor older people may help reduce blood pressure , Evidence-based cardiovascular medicate , vol .10 , pp .52-55Fu , D , incision , Y , McGowan ,Fu , H 2006 , qualitative evaluation of chronic diseaseself management program (cdsmp ) in instill , Patient nurture and advise , vol .61 , pp .389-396Gebert , N , Hummelink , R , Konning , J , Staab , D , Schmidt , S , Szczepanski R , Runde , BWahn , U 1998 , Efficacy of a self-management program for childhood asthma-A prospective controlled study , Patient Education and Counseling vol .35 , pp . 213-220Ghosh , Cs , Ravindran ,, Joshi , M Stearns , Sc 1998 , Reductions in hospital use fromSelf-management training for chronic asthmatics , Social skill Medicine , vol .46 , n o .8 , pp .1087-1093Grey , M , Knafl , K McCorkle , R 2006 , A framework for the study of self- and familymanagement of chronic conditions , nursing Outlook , vol .54 , pp .278-286Hacke , W , Kaste , M , Olsen , TS , Orgogozo , JM Bogousslavsky 2000 European StrokeInitiative (EUSI ) recommendations for stroke management : The European stroke possibility writing committee , European Journal of Neurology vol .7 , pp .607-623Jaracz , K , Jaracz , J , Kozubski , W Rybakowski , JK 2002 , Post-stroke role of life anddepression , Acta Neuropsychiatrica , vol .14 , pp .219-225Kostanjsek , N 2004 International Classification of Functioning Disability and Health(ICF : Overview of teh ICF framework and its utility for disability statisticsMant J , Carter J , Wade DT , et al 2000 , Family support for stroke : a randomisedcontrolled trial . fizgig , vol .356 ,808-813Mant , J , Winner , S , Roche , J Wade , DT 2005 , Family support for stroke one yearfollow up of a randomised controlled trial . Journal of Neurology Neurosurgery and Psychiatry ! , vol .76 , pp .1006-1008Pohjasvaara , T , Vataja , R , Leppavuori , A , Kaste , M and Erkinjuntti , T 2001 , Depressionis an independent predictor of poor long-term functional outcome post-stroke , European Journal of Neurology 2001 , vol .8 , 315-319Proot , IM , Crebolder , HFJM , Abu-Saad , HH , Macord , HGM Meulen , Ruud HJT2000 , Stroke patients needs and experiences regarding autonomy at discharge from nursing home , Patient Education and Counseling , vol . 41 pp .275-283Rimmer , JH , Braunschweig , C , Silverman , K , Riley , B , Creviston , T Nicola , T 2000Effects of a short-term health promotion intervention for a predominantly african-american group of stroke survivors , American Journal of Preventive Medicine , vol .18 , no .4 , pp .332-338Scholz , U , Knoll , N , Sniehotta ,FF Schwarzer , R 2006 , Physical activity anddepressive symptoms in cardiac rehabilitation : Long-term effects of a self-management intervention , Social Science Medicine , vol .62 pp .3109-3120Sol , BGM , van der Graaf , Y , van der Bijl , JJ , Goessens , NBG Visseren FLJ 2006Self-efficacy in patients with clinical manifestations of vascular diseases Patient Education and Counseling , vol .61 , pp .443-448 Stroke n .d , The Department of Health , retrieved October 14 , 2006 fromhttp /www .dh .gov .uk /PolicyAndGuidance /HealthAndSocialCares /Stroke fs /enTruelsen , T , Piechowski-Jo ?z ?wiak , B , Bonitaa , R , Mathersa , C Bogousslavsky , JBoysend , G 2006 , Stroke incidence and prevalence in Europe : a review of available data , European Journal or Neurology , vol .13 , pp .581-598Van den Heuvel , ETP , De Witte , LP , Nooyen-Haazen , I , Sanderman , R Meyboom-deJong , B 2000 , Short-term effects of a group support program and an individual support program for caregivers of stroke patients , Patient Education and Counseling , vol .40 , pp .109-120Wolfe , CDA , rudd , AG , Howard , R , Coshall , C , Stewart , J , Lawrence , E Hajat , CHillen , T 2002 , Incidence and case want rates of stroke subtypes in amultiethnic populat! ion : the South London Stroke Register , Journal of Neurology , Neurosurgery and Psychiatry , vol .72 , pp .211-216Zarnke , KB , Feagan , BG , Mahon , JL Feldman , RD 1997 , A randomized studycomparing a patient-directed hypertension management strategy with usual office-based care , American Journal of Hypertension , vol .10 , pp .58-67PAGEPAGE 20 ...If you want to get a full essay, order it on our website:
OrderCustomPaper.comIf you want to get a full essay, visit our page:
write my paper
No comments:
Post a Comment