Frequently Asked Questions
- What is Bridges?
- Why is a self-management programme needed?
- How has Bridges been developed?
- Can Bridges be used with all stroke survivors?
- Where have the workshops been held?
- What do patients think?
- What do clinicians think?
- Who are the training workshops for?
- What does the Bridges programme provide?
- How much does a Bridges workshop cost?
- Do I have to purchse on-going supplies of stroke workbooks? And what would the costs be?
What is Bridges?
Bridges aims to provide stroke survivors with the opportunity to develop their self-management skills via an individualised programme delivered by trained practitioners based on self-efficacy research.
The Bridges programme has been designed in consultation with stroke survivors. It recognises that stroke is a unique and complex event, and that one size doesn’t fit all. It can be used alongside regular therapy or after discharge from rehabilitation.
There are 2 main components to the Bridges programme:
1. Workshops and Support for stroke practitioners to enable the learning of effective skills, theory and research relevant to stroke self-management, allowing the use of the Bridges approach via a series of one to one self-management sessions with the stroke survivor.
2. The provision of personalised, interactive, stroke workbooks given to practitioners to work with the stroke survivor to support their self-management. The stroke workbook includes individual stories and strategies suggested by stroke survivors, together with a diary section to record personal targets and successes.
Why is a self-management programme needed?
Stroke is the most complex and prevalent disability in the UK affecting over 130,000 people in England and Wales alone. In the UK, stoke costs £4.2 billion in terms of lost productivity, disability and informal care costs.
The National Stroke Strategy (2007) recommends that a range of programmes to support self-management skills after stroke are needed, to reduce long term care costs.
The DoH in the document ‘Supporting people with Long-term conditions to self-care: a guide to developing local strategies and good practice’ (2006), underlines the need for new approaches based on an increasing body of evidence, to enable people with long-term conditions to self-care , and live as normal life as possible.
Systematic reviews of the experiences of living with stroke reveal a complexity of problems faced by people in the longer term, including social isolation and mood disorders. It is often reported that many stroke survivors feel abandoned and ill prepared for coping with life after discharge from regular therapy.
How has Bridges been developed?
Bridges was originally conceived by Dr Fiona Jones (physiotherapist and academic in stroke) in 2005. Preliminary testing using a series of single-case studies (n=10), revealed a statistically significant change in self-efficacy, and improved activity, participation and mood in all participants following the intervention.
Jones F, Mandy A, Partridge C. (2009) Changing self-efficacy in individuals following first stroke: preliminary study of a novel self-management intervention. Clinical Rehabilitation. 23, 6: 522-533
The ongoing development has since been strongly influenced by policy context and research in stroke and self-management
Early in 2007, the Bridges programme was tested in three pilot sites (Inverness, London, and Christchurch). Over 45 nurses and allied health professionals attended an introductory workshop, and 150 stroke workbooks were distributed. Follow-up events to gain feedback about the workshops and stroke workbook were subsequently held in all pilot sites later in 2007. Feedback was positive and informed the development of the final training programme for practitioners and stroke workbook.
A multiprofessional expert Project Advisory Group, was established in January 2007, and has since guided the development of Bridges. The Group includes Stroke Survivors, Carers, Stroke Consultant, OT, Physiotherapist, Nurse Consultant Psychologist and advisors from Connect (UK Charity for people with Aphasia)
In February 2008 the stroke workbook was evaluated by communication advisors at Connect and considerable effort has been made to incorporate their suggestions into the final version of the stroke workbook, now completed. This has made the workbook more accessible for individuals with aphasia. Use the following link for more information.
http://www.ukconnect.org/news_0_355.aspx
The first team workshop was held in Dundee in April 2008 and the first London based team workshop was held in July 2008 at Imperial Healthcare Trust.
Bridges has recently launched as a Social Enterprise based within the Faculty of Health and Social Care Sciences (St George's, University of London and Kingston University). Bridges is dedicated to doing research in stroke and self-management and incorporating this research and feedback from workbook users and clinicians to continuously update our products. All profits generated by Bridges are re-invested into the project for further research.
Can Bridges be used with all stroke survivors?
Bridges has been tested in a series of single-case studies, with participants between 12-72 weeks post stroke. The one-to-one sessions all took place after discharge from hospital.
At the 3 pilot sites practitioners worked in both acute and community settings.
Following focus groups with practitioners we learned that Bridges was introduced in the acute setting and at different stages of the stroke pathway, but will depend for the most part on the readiness of the individual stroke survivor.
We anticipate that Bridges can be used as early as 2-3 weeks post stroke, and there is no limit to how long post stroke. Many of the stories/cases in the workbook are from people who are many years post stroke.
In 2008 a phase 1 randomised controlled trial commenced in Northern Ireland, with the results of this study providing more information about feasibility, acceptability and timing of Bridges. The study is recruiting patients who are more than 4 weeks post stroke. Preliminary analysis from exit interviews has demonstrated a positive reaction to the programme, for using the stroke workbook to support self-management.
Where have the workshops been held?
Since the first workshops in London and Dundee in 2008, team workshops have been delivered in Surrey, London, Swindon, Derby, North and South Wales, and Scotland. A total of 27 workshops have been commissioned, with more than 500 clinicians (therapists, nurses, doctors, and support workers) receiving the two-stage workshop.
We have summaries of all the evaluation forms from workshops available on request. Alternatively we have details of teams that have hosted workshops who are able to provide feedback on using the programme.
Case reflections prepared by attendees for the second workshop, have been analysed and used to inform the development of the training and redesign of the stroke workbook. This work was presented at the UK Stroke Forum, December 2009.
Jones F, Lennon S (2009) A new stroke self-management programme: preliminary analysis of training for practitioners. International Journal of Stroke. 4:s2: 23.
More information about development of the programme can be found in the following publication;
Jones F (2008). Stepping Out: A programme focusing on self-management after stroke. International Journal of Therapy and Rehabilitation 15(12): 540-541
What do patients think?
Our programme has been informed by stroke survivors and carers since its inception. We have patient involvement in the design and content of the stroke workbook, and the development of the programme. Feedback to clinicians has included the following
- Patient appeared positive about the workbook and reading about other people who had had strokes and setting goals
- Showed great interest and keen to look over workbook independently, highlighted a person in the book with a similar problem which he could relate to
- Initially he appeared apprehensive about the workbook, felt daunted by setting targets
- Patient learned some self-awareness, he became more encouraging to others once he had established and gained insight with regard to his progress and goals
- The absorption of the workbook was better than expected, she identified with the issues Comfort had described, and that she was definitely not a risk taker like ‘Regina’. She started planning ahead for future goals and thinking resourcefully about how she progress further without therapy input
Eileen Collins, a stroke survivor was a participant in the initial research project on Bridges. She was supported to use the stroke workbook over a period of 4 weeks and is now a member of the project advisory group; the following is her reflection on using the stroke workbook
‘The self-management workbook really helped me, there were lots of people in the workbook and they gave me hope, it was the first time since my stroke I had hope’
‘I read the book to begin with, and then I had another small stroke, I started looking at the workbook properly after that, I didn’t realise how fed up I was, looking in it regularly made me realise I can make some small steps to make progress in my life, and that those small steps could add up to giant steps’
What do clinicians think?
The Bridges Programme has been evaluated as one of the Stroke Improvement Plan’s Priority projects. The final analysis is still in preparation, below is a summary of the feedback from clinicians in response to a final questionnaire given at the follow-up workshop
What are the Main barriers to using a self-management programme in the stroke pathway
- Difficult to use with people with cognitive, perceptual and communication deficits
- Takes time which is limited in the acute setting
- Difficult when patients have limited motivation
- Too early in recovery – patients often still adjusting to whats happened to them/finding out what they have lost/kept
- Some difficulties in using the programme alongside traditional rehab (6)
- Important to ensuring people liaise between teams when a patient has been started on the stepping out project
- Not easy when the whole team has not been trained
- Time pressures to “push through” patients
- Considerable number of patients have low self-efficacy
- Patient goals too ambitious
What factors (if any) contribute to the success of using the Bridges programme
- Just doing it – giving it a go and getting some practice
- Knowing the content reasonably well
- Involving family
- Having MDT support – patients seeing several therapists may need support with targets
- Using it flexibly e.g with family, different sections, etc
- Allowing required time, support of manager/team
- Introducing at the right time – acute v’s community
- The therapist believes it
- Letting the patient set their own goals in own words
- Patient chooses an important goal to themselves
- Knowing other clinicians on stroke pathway are trained to use it
- Incorporating self-management into daily practice
- Commitment of the clinician
- Commitment of the patient/family
- Continuing to use the book throughout the pathway
- Belief in the concept and commitment
- Confidence in the use of the book
Can it be used throughout the stroke pathway?
- Yes but uses more limited in acute stage
- Yes, if we do not try it then we will never know
- It may help with communication dependent on existing relationships between services
- Now that I understand that the book can be introduced in the inpatient setting – yes. I felt from the initial course that it was expected that the therapist has to work throughout the phase
- I think it potentially could however the pathway therapists need to get together and discuss how the transition of care/self management concept is taken forwards. At the present time there is limited communication between the teams about self-management. Team based self-management for patient, not patient managed self-management
- Yes with the commitment of staff
How could it influence transfer of care?
- With a lot of commitment and energy and management drive – yes
- Increase patient ownership
- More communication between services, indication that is has been used along a pathway, may help patient to begin to think about targets so we are all singing from the same songsheet
- May facilitate in process of transfer of care with continuity
- In theory yes but severely dysphasic patients may benefit through working with carers
- Improve patient progress to achieving goals they have set
- I think it will ensure better transfer of care – better handover, etc. As long as the book is not lost in transit!
- Yes if discussed first. Transition of goals and maintain continuity of care
- Possibly. I think that the patient experience would be better. Communication and focus of goal setting may be better
- Put client in charge of own pathway leads to continuity of care
- Aid continuity of care
- Greater help goal setting when transferring through the service
- The same goals would be aimed for by all clinicians and teams involved
- The patient will feel less vulnerable and more in control
- Helpful for transitional stages
- Help patient to focus on what they want to achieve at difficult stages of their journey
- More seamless transfer of goals
Has your practice changed since the introductory workshop? If yes, how?
- Goals making more sense. I have recently moved into rehab from the acute setting Increased discussions around ongoing goals following discharge
- Go with patients long term targets, do not feel I have to be the one who has to tell them it may not get better – this is only based on my belief, people need hope for the future
- More aware of promoting self-efficacy of the patient
- No – I feel like I need more training to increase my own core skills in facilitating the process
- Yes – spending more time to goal set
- More formal ways of doing things we are already doing
- Enhanced practice
- Much more aware of how I facilitate the setting of goals and ensure not as therapist led
- Yes – willingness to take on goals that are unrealistic
- Yes – further support my own philosophy and has provided a useful tool Yes – I am much more aware of patient led goals and now involve my patients more rather than suggesting things for them to work on No not yet
- Been more aware of the whole concept of self-efficacy
Who are the Bridges training workshops for?
Bridges workshops are aimed at all stroke professionals, including: nurses, physiotherapists, occupational therapists, speech and language therapists, psychologists, doctors and any other health care practitioners working within the stroke pathway.
We expect that the majority of our workshops will be team workshops, delivered to members of the same stroke team or pathway. However we do plan to hold open workshops based at St George’s, University of London for individual practitioners who are unable to host their own workshop.
What does the Bridges training programme provide?
Bridges delivers self-management training for practitioners working in stroke rehabilitation to encourage stroke survivors to take control of their daily lives.
There are 2 main components to the Bridges programme:
1. Workshops and Support for stroke practitioners to enable the learning of effective skills, theory and research relevant to stroke self-management, allowing the use of the Bridges approach via a series of one to one self-management sessions with the stroke survivor.
2. The provision of personalised, interactive, stroke workbooks given to practitioners to work with the stroke survivor to support their self-management. The stroke workbook includes individual stories and strategies suggested by stroke survivors, together with a diary section to record personal targets and successes.
Workshops
Workshops are aimed at all stroke professionals, including nurses, physiotherapists, occupational therapists, speech and language therapists, psychologists, doctors and any other health care practitioners working within the stroke pathway.
Each Workshop is a two-stage certification process of two separate days with an intervening period of 3-6 months.
Day 1: Introduction to Bridges
The session enables participants to develop effective strategies to encourage self-management after stroke. Participants explore the Bridges model with examples from current research in stroke rehabilitation and chronic disease self-management. There is an opportunity to discuss person-centred rehabilitation in the context of National Stroke Guidelines and DOH policy.
Day 1 will enable participants to:
- Discuss the enablers and barriers to effective self-management in the longer-term post stroke.
- Outline research on chronic disease self-management.
- Demonstrate methods of enhancing self-efficacy in stroke survivors.
- Explain the Bridges Programme and Workbook.
- Develop greater awareness of communication techniques.
Day 2: Follow-up
This day requires participants to report on and discuss at least one Bridges case study.
Day 2 will enable participants to:
- Critically reflect on their use of the Bridges approach.
- Discuss research in the context of current stroke policy.
- Use strategies to promote individual readiness of stroke survivors for self-management training.
In addition we provide:
- A comprehensive resource pack for participants to support the introductory workshop;
- 5 copies of the Stroke Workbook per participant;
- Telephone support and advice to Bridges workshop attendees;
- Access to the Bridges discussion forum for participants to share ideas and receive expert advice from the Bridges team;
- Extra workbooks at a reduced rate.
How much does a Bridges workshop cost?
Team Workshop:
- £3050 for up to ten participants.
- £255 per additional participant (up to a maximum of 20).
Costs include 5 copies of the Stroke Workbook and resource pack per participant, access to our web-based interactive discussion forum and email support.
Costs do not include travel and overnight accommodation for one Bridges trainer (if required), venue hire or catering costs, postage and packaging.
All costs are introductory costs for NHS employees.
Do I need to purchase ongoing supplies of the stroke workbook? And what would the costs be?
The cost of the introductory Bridges workshop includes 5 copies of the Bridges workbook. We anticipate that additional copies will be needed by some stroke teams and extra copies can be purchased at the following prices:
Orders for 100 workbooks or more: £15 per workbook
Orders for less than 100 workbooks: £17.50 per workbook
Total Cost for 50 = £875
Total cost for 75 = £1312.50
Total cost for 100 = £1500
All costs are introductory costs for NHS employees.
