Self-management of upper limb recovery after stroke: how effectively do occupational therapists and physiotherapists train clients and carers?

Aim: A self-management approach to upper limb management following stroke has received little attention in the literature. The aim of the study was to investigate the impact of occupational therapists' and physiotherapists' standard practice on clients' and carers' self-management of upper limb recovery. Method: Fifteen clients, 7 carers, 11 occupational therapists and 7 physiotherapists were recruited. Therapists described five self-administered tasks they expected clients and carers were doing, using the Goal Attainment Scale (GAS). For each task, clients' and carers' performances were then evaluated using the GAS and their self-efficacy was rated on a 10-point Likert scale. A survey questionnaire investigated their perceptions of the training provided, with respect to a self-management approach. Results: At least a quarter of the self-administered tasks related to upper limb activity, strengthening and secondary prevention were performed below therapists' expectations. In contrast, mean self-efficacy ratings across these tasks were high (clients = 7.8-9.5, carers = 8.5-8.9). Seventy per cent of the self-management training strategies listed in the survey questionnaire were considered missing by more than 40% of carers. Conclusion: There is a need for therapy resources that enhance the content and delivery of self-management training related to upper limb management following stroke, particularly for carers.