This environment for stroke services is not where the problem lies you blithering idiots. You're allowing billions of neurons to die in the first week because absolutely nothing has been done to solve the 5 causes of the neuronal cascade of death in the first week saving billions of neurons.
Built environments for inpatient stroke rehabilitation services and care: a systematic literature review
Abstract
Objectives To identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke, their family/caregivers and staff.
Design A convergent segregated review design was used to conduct a systematic review.
Data sources Ovid MEDLINE, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched for articles published between January 2000 and November 2020.
Eligibility criteria for selecting studies Qualitative, quantitative and mixed-methods studies investigating the impact of the built environment of inpatient rehabilitation facilities on stroke survivors, their family/caregivers and/or staff.
Data extraction and synthesis Two authors separately completed the title, abstract, full-text screening, data extraction and quality assessment. Extracted data were categorised according to the aspect of the built environment explored and the outcomes reported. These categories were used to structure a narrative synthesis of the results from all included studies.
Results Twenty-four articles were included, most qualitative and exploratory. Half of the included articles investigated a particular aspect of the built environment, including environmental enrichment and communal areas (n=8), bedroom design (n=3) and therapy spaces (n=1), while the other half considered the environment in general. Findings related to one or more of the following outcome categories: (1) clinical outcomes, (2) patient activity, (3) patient well-being, (4) patient and/or staff safety and (5) clinical practice. Heterogeneous designs and variables of interest meant results could not be compared, but some repeated findings suggest that attractive and accessible communal areas are important for patient activity and well-being.
Conclusions Stroke rehabilitation is a unique healthcare context where patient activity, practice and motivation are paramount. We found many evidence gaps that with more targeted research could better inform the design of rehabilitation spaces to optimise care.
PROSPERO registration number CRD42020158006.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplemental information. The results from the articles included in this systematic review are summarised in the supplemental material.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplemental information. The results from the articles included in this systematic review are summarised in the supplemental material.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Twitter @RubyLipsonSmith, @AVERTtrial
Contributors JB, ME, S-MB, MW and HZ conceived and planned the protocol for this study. S-MB developed and executed the search strategy. RL-S and LP assessed the articles for eligibility and conducted the data extraction. RL-S conducted the analysis and synthesis of the included studies. RL-S, LP, S-MB, ME, AD, MW, HZ and JB prepared the draft of the manuscript and edited, read and approved the final version of the manuscript.
Funding This research was funded by the Felton Bequest and the University of Melbourne as part of the Neuroscience Optimised Virtual Environment Living Lab (NOVELL) Redesign Project. JB is funded by an NHMRC Research Fellowship (1154904). The Florey Institute of Neuroscience and Mental Health acknowledges the support from the Victorian government and in particular the funding from the Operational Infrastructure Support Grant.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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