Survivor-led self-management programs help with living in the community

A new recommendation in the Living Clinical Guidelines for Stroke Management says that self-management interventions that are directed by the survivor of stroke should be offered within the first four months after they’ve been discharged to live in the community.

This guidelines update was officially approved by the National Health and Medical Research Council (NHMRC) on 2 January 2025. It was largely based on strong evidence from a clinical trial of the Take Charge program, which was developed in New Zealand and piloted with Māori and Pacific Islander people.

Take Charge is a talking therapy with an illustrated workbook that encourages survivors of stroke to explore the ‘big life’ questions, to help them get a sense of purpose, autonomy, mastery, and connectedness with others.

Through one or two self-reflective talking sessions, the survivor focuses on their attitude to life and the support they have around them. The program involves trained clinicians acting as facilitators, but the discussions are guided by the survivor. Family members or friends can also be present at the person’s request.

Together with the original pilot study, this trial found clear benefits 12 months after stroke, with greater independence and improved quality of life.

As part of the living guidelines update process, the content working groups examined evidence for other participant-led programs. These were found to be safe and feasible, but the individual benefits were less clear and require further study.

Further information and access to the Take Charge booklet and training manual can be found at the Medical Research Institute of New Zealand (MRINZ).