Oral Presentation Asia Pacific Stroke Conference 2024

Coming to my own wisdom: exploring the mechanisms of action of the Taking Charge After Stroke (TaCAS) intervention (107540)

Vivian WY Fu 1 2 , Kathryn Fernando 2 , Felicity Bright 3 , Judith Riley 2 , Kathryn McPherson 3 , Harry McNaughton 2
  1. University of Calgary, Calgary, ALBERTA, Canada
  2. Medical Research Institute of New Zealand, Wellington, New Zealand
  3. Centre for Person Centred Research, AUT University, Auckland, New Zealand

BACKGROUND/AIMS

The Take Charge intervention, delivered early after hospital discharge following acute stroke, is effective at improving 12-month health status, independence and advanced activities of daily living.1,2 This study aimed to provide a deeper understanding of the mechanism of action of this ‘talking therapy’.

METHODS

We completed a qualitative investigation based on interviews with 9 participants of the Taking Charge after Stroke (TaCAS) trial, three from each of the three arms of the trial: receiving two, one, or zero Take Charge sessions (the control group). Purposive sampling, semi-structured interviews, thematic analysis were used.

RESULTS

The overall theme of ‘Doing things my way / coming to know my own wisdom and expertise’ was enabled by ‘being listened to and feeling heard’ and ‘focusing on the goals which were important to me’, both strongly expressed by people who received the Take Charge intervention, and hindered by ‘medical paternalism’ and ‘loss of sense of self / “not me”’ most commonly expressed by people in the control arm.

CONCLUSION

These findings extend our understanding of the mode of action in the Take Charge intervention and provide material for further development of the tool as well as a re-appraisal of aspects of current rehabilitation practice.

  1. 1. Harwood M, Weatherall M, Talemaitoga A, Barber PA, Gommans J, Taylor W, McPherson K, McNaughton H. Taking charge after stroke: promoting self-directed rehabilitation to improve quality of life--a randomized controlled trial. Clin Rehabil. 2012 Jun;26(6):493-501. doi: 10.1177/0269215511426017. Epub 2011 Nov 15. PMID: 22087047.
  2. 2. Fu V, Weatherall M, McPherson K, Taylor W, McRae A, Thomson T, Gommans J, Green G, Harwood M, Ranta A, Hanger C, Riley J, McNaughton H. Taking Charge after Stroke: A randomized controlled trial of a person-centered, self-directed rehabilitation intervention. Int J Stroke. 2020 Dec;15(9):954-964. doi: 10.1177/1747493020915144. Epub 2020 Apr 15. PMID: 32293236; PMCID: PMC7739137.