In perspective - A power-sharing agreement

Broadcaster Andrew Marr’s stroke highlights the need to share expertise with patients, says ACPIN president Fiona Jones

Many of you will have seen Andrew Marr’s brief appearance on his own Sunday show last month.

He reflected on his stroke and how he feels lucky to be alive.

His certainty that the only way forward is ‘intensive physiotherapy’ together with his own hard work was no doubt gratifying, but for me also underscored the necessity to understand each person’s health beliefs and motivations in relation to their recovery from disability or injury.  

A recent Stroke Association report shows that many people feel abandoned when discharged from stroke rehabilitation.

Do we propagate a reliance on our expertise and skills which could leave a person feeling inadequately prepared to manage their continued progress after discharge?

Physiotherapy may make an important contribution to a person’s physical recovery but can also help in supporting confidence and adjusting to living with a disability.

Much of my research has centred on how to support people in the longer-term after a stroke, and on the development of a stroke specific self-management programme.

The term self-management can be misleading. It’s not about giving advice on exercises but should be about problem-solving, reflecting together on what works, and using past experiences to promote personal resourcefulness.

A recent King’s Fund report talks of ‘sharing expertise’ as a component of successful self-management.

Taking that idea further, anyone who has a stroke also has expertise in coping with setbacks in their lives.

Our research shows some physios worry that this way of working will take extra time, whether individuals are ready to set goals, or whether patients will want to make decisions about their care.

But two sources of expertise are available – so let’s relinquish a little power and share!
Coulter A, Collins A (2011) Making shared decision-making a reality: No decision about me, without me. King’s Fund.
Jones F et al (2012) ‘Getting the Balance between Encouragement and Taking Over’: Reflections on using a new stroke self-management programme. Physiotherapy Research International ePub doi:10.1002/pri.1531

Fiona Jones is reader in rehabilitation, St George’s University of London and president of the Association of Chartered Physiotherapists in Neurology

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