national-clinical-guidelines-for-stroke-fourth-edition

self-esteem, and there are relationships between self-efficacy and emotional states
(depression, anxiety), and quality of life.
Evidence to recommendations
There is a small emerging evidence base (systematic reviews and RCTs) on the utility of
changing self-efficacy in attempts to increase independence. Self-efficacy can also be one
of many predictors of independence. One way has been to promote self-management
skills through individual or group-based programmes.
6.18.1 Recommendations
6.18.2 Sources
A All patients should be offered training in self-management skills, to include active
problem-solving and individual goal setting.
B Any patient whose motivation and engagement in rehabilitation seems reduced
should be assessed for changes in self-identity, self-esteem and self-efficacy (as well as
changes in mood; see section 6.35).
C Any patient with significant changes in self-esteem, self-efficacy or identity should be
offered additional (to A) psychological interventions such as those referred to in
section 6.35.
A–B Consensus
C Kendall et al 2007; Watkins et al 2007; De Man-van Ginkel et al 2010; Jones and
Riazi A 2010
6.19 Pain management
Pain is a frequent problem after stroke and can be due to many causes such as neuropathic
pain, musculoskeletal pain including spasticity, and depression. It may also be due to a
pre-existing problem which is not directly related to the stroke. As with many post-stroke
issues, it may be more difficult to evaluate in patients with communication problems.
6.19.1.1 Recommendations
A Every patient with stroke should be asked whether they have any pain, and its severity
assessed using a validated score at onset and regular intervals thereafter. Each review
should include assessment of:
● pain reduction
● adverse effects
6 Recovery phase from impairments and limited activities: rehabilitation
● daily activities and participation (such as ability to work and drive)
● mood (in particular, whether the person may have depression and/or anxiety)
● quality of sleep
● overall improvement as reported by the person.
B All patients complaining of, or experiencing pain, should have the cause of the pain
diagnosed.
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