Create protocols for 100% recovery and inactivity wouldn't exist. SOLVE THE CORRECT PROBLEM! Your survivor would be too busy counting reps and looking forward to recovery. DO YOU NOT UNDERSTAND?
Addressing inactivity after stroke: The Collaborative Rehabilitation in Acute Stroke (CREATE) study.
Fiona Jones1*, Karolina Gombert-1, Stephanie Honey2, Geoffrey Cloud3,4, Ruth Harris5, Alastair
Macdonald6, Christopher McKevitt7, Glenn Robert4, David Clarke2
1Faculty of Health, Social Care and Education. Kingston University & St George’s, University of
London. UK.
2Leeds Institute of Health Sciences. University of Leeds, UK
3Alfred Health, Melbourne, Australia.
4 Department of Clinical Neurosciences, Central Clinical School, Monash University, Melbourne,
Australia
5Faculty of Nursing, Midwifery and Palliative Care, King’s College London. UK.
6School of Design, Glasgow School of Art. UK.
7School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King’s
College London. UK.
*Corresponding author.
Corresponding author contact details: f.jones@sgul.kingston.ac.uk
Keywords. Stroke, inactivity, co-design.
Word Count
Tables and Figures
Table 1 Timings of data collection and the methods used
Table 2 Excerpts from analysis of field notes and interviews and how priorities were shaped
Table 3 Demographic details patient participants
Table 4 Staff participants
Table 5 Carer participants
Table 6 Co-design group characteristics
Table 7 Co-design groups in each site
Table 8Impact of co-designed changes
Table 9- Pre and post implementation Behavioural Mapping data
Figure 1 Showing Accelerated and Full Experienced-based Co-design with pre and post
implementation data Collection
brought to you by COREView metadata, citation and similar papers at core.ac.uk
provided by Kingston University Research Repository
Background: Stroke patients are often inactive outside of structured therapy sessions – an enduring
international challenge despite large scale organisational 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 n=156 patients, staff and carers, ethnographic observations –n=365 hours,
behavioural mapping n=68 patients, and self-report surveys n=182 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. Behavioural
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.
Macdonald6, Christopher McKevitt7, Glenn Robert4, David Clarke2
1Faculty of Health, Social Care and Education. Kingston University & St George’s, University of
London. UK.
2Leeds Institute of Health Sciences. University of Leeds, UK
3Alfred Health, Melbourne, Australia.
4 Department of Clinical Neurosciences, Central Clinical School, Monash University, Melbourne,
Australia
5Faculty of Nursing, Midwifery and Palliative Care, King’s College London. UK.
6School of Design, Glasgow School of Art. UK.
7School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King’s
College London. UK.
*Corresponding author.
Corresponding author contact details: f.jones@sgul.kingston.ac.uk
Keywords. Stroke, inactivity, co-design.
Word Count
Tables and Figures
Table 1 Timings of data collection and the methods used
Table 2 Excerpts from analysis of field notes and interviews and how priorities were shaped
Table 3 Demographic details patient participants
Table 4 Staff participants
Table 5 Carer participants
Table 6 Co-design group characteristics
Table 7 Co-design groups in each site
Table 8Impact of co-designed changes
Table 9- Pre and post implementation Behavioural Mapping data
Figure 1 Showing Accelerated and Full Experienced-based Co-design with pre and post
implementation data Collection
brought to you by COREView metadata, citation and similar papers at core.ac.uk
provided by Kingston University Research Repository
Background: Stroke patients are often inactive outside of structured therapy sessions – an enduring
international challenge despite large scale organisational 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 n=156 patients, staff and carers, ethnographic observations –n=365 hours,
behavioural mapping n=68 patients, and self-report surveys n=182 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. Behavioural
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.
Read Dean's Comments 100% closer to solving the issue than 10's of thousands waisted on lab rat work.
ReplyDeleteSigned,
A recovering stoker left to my own devices ConcreteTim