Rehabilitation Environments: New Insights to Guide Stroke Inpatient Service Redesign

 You're not thinking properly; there's tons of research just needing followup and use that to CREATE EXACT REHAB PROTOCOLS!  

You're missing the point; you don't understand how research should work? Create EXACT REHAB PROTOCOLS AND GET SURVIVORS RECOVERED! 

See, that's not difficult to understand, is it? 

Delivering that is hard, so get to fucking work!

Oops I shouldn't take superstar Julie Bernhardt's name in vain! Call me and we can discuss where to go from here.

Prof Julie Bernhardt (13 posts to February 2018)

Rehabilitation Environments: New Insights to Guide Stroke Inpatient Service Redesign

 Juan Pablo Saa, PhD, MPH, OTD, BSc https://orcid.org/0000-0001-5483-3559 saajp@outlook.com 

Ruby Lipson-Smith PhD https://orcid.org/0000-0002-1702-8144 

Marcus White, PhD https://orcid.org/0000-0002-2238-9251 

Aaron Davis PhD, MBA https://orcid.org/0000-0002-1477-7406&nbp;

Rhonda Kerr PhD https://orcid.org/0000-0003-4482-9323 

Julie Bernhardt PhD https://orcid.org/0000-0002-2787-8484 on behalf of NOVELL redesign Author Info & Affiliations Stroke Volume 57 Number 1 https://doi.org/10.1161/STROKEAHA.125.051390 

BACKGROUND:

Inpatient rehabilitation plays a pivotal role in the stroke recovery continuum. We have previously shown how rehabilitation clinical guidelines and health care design guidelines may not fully align to support recovery needs. Building on our previous work describing the current stroke inpatient rehabilitation service, we aimed to articulate and propose recommendations for an optimal inpatient service through the integration of stakeholder feedback, clinical guidelines, and health care design principles.

 

METHODS:

We used value-focused thinking, living-lab, and codesign principles to evaluate a re-imagined stroke rehabilitation service.(But you incorrectly are not imagining 100% recovery, WHICH IS WHERE YOU COMPLETELY FAILED!) Participants reviewed 21 care process activity blocks derived from our previous work, with proposed changes to the admission, discharge processes, and weekday routines (morning, afternoon, and evening) of a typical Australian inpatient stroke service. Participants used an agreement scale to rate the proposed changes against predefined objectives focusing on safety, efficiency, emotional well-being, and opportunities for practice, rest, and autonomy. The reimagined stroke service was reviewed and iteratively refined through further validation sessions with selected participants.

RESULTS:

Twenty-six stakeholders participated in our evaluation, including stroke survivors, caregivers, clinicians, researchers, and health care facility designers and planners. Nineteen activity blocks were rated, generating 152 individual votes and 15 recommendations for service improvement. Overall, the agreement rate across all proposed changes was 76%. The highest agreement was observed in the evening (100%) and admission (81%) blocks, with strong endorsement for improved information delivery and environmental flexibility. Lower agreement was noted for discharge (61%), reflecting the complexity and varied perspectives on transition planning. Validation with 7 participants confirmed the relevance and feasibility of most proposed changes, especially those that support personalization, autonomy, and early engagement.

CONCLUSIONS:

 Stakeholder-informed redesign of stroke rehabilitation services can enhance alignment between clinical processes and environmental enablers. These findings offer a practical foundation for codesigned models of care that are both evidence-based and experientially grounded. 

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