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Addressing inactivity after stroke : the Collaborative Rehabilitation in Acute Stroke (CREATE) study
- Source :
- International Journal of Stroke
- Publication Year :
- 2021
- Publisher :
- SAGE Publications, 2021.
-
Abstract
- Background Stroke patients are often inactive outside of structured therapy sessions – an enduring international challenge despite large scale organizational changes, national guidelines and performance targets. We examined whether experienced-based co-design (EBCD) – an improvement methodology – could address inactivity in stroke units. Aims To evaluate the feasibility and impact of patients, carers, and staff co-designing and implementing improvements to increase supervised and independent therapeutic patient activity in stroke units and to compare use of full and accelerated EBCD cycles. Methods Mixed-methods case comparison in four stroke units in England. Results Interviews were held with 156 patients, staff, and carers in total; ethnographic observations for 364 hours, behavioral mapping of 68 patients, and self-report surveys from 179 patients, pre- and post-implementation of EBCD improvement cycles. Three priority areas emerged: (1) ‘Space’ (environment); (2) ‘Activity opportunities’ and (3) ‘Communication’. More than 40 improvements were co-designed and implemented to address these priorities across participating units. Post-implementation interview and ethnographic observational data confirmed use of new social spaces and increased activity opportunities. However, staff interactions remained largely task-driven with limited focus on enabling patient activity. Behavioral mapping indicated some increases in social, cognitive, and physical activity post-implementation, but was variable across sites. Survey responses rates were low at 12–38% and inconclusive. Conclusion It was feasible to implement EBCD in stroke units. This resulted in multiple improvements in stroke unit environments and increased activity opportunities but minimal change in recorded activity levels. There was no discernible difference in experience or outcome between full and accelerated EBCD; this methodology could be used across hospital stroke units to assist staff and other stakeholders to co-design and implement improvement plans.
- Subjects :
- Co-design
medicine.medical_specialty
Scale (ratio)
medicine.medical_treatment
03 medical and health sciences
0302 clinical medicine
Physical medicine and rehabilitation
Surveys and Questionnaires
medicine
Humans
030212 general & internal medicine
Stroke
Acute stroke
Rehabilitation
business.industry
Research
Stroke Rehabilitation
Health services research
health
medicine.disease
primarycare
Hospitals
inactivity
Caregivers
Neurology
co-design
business
Hospital Units
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- ISSN :
- 17474930 and 17474949
- Database :
- OpenAIRE
- Journal :
- International Journal of Stroke
- Accession number :
- edsair.doi.dedup.....cdcb9300624f30d035e7caa594ed706e