Ingrid Cm Rosbergen1,2, Rohan S Grimley3, Kathryn S Hayward1,4,5,6, Katrina C Walker2, Donna Rowley7, Alana M Campbell2, Suzanne McGufficke2, Samantha T Robertson2, Janelle Trinder7, Heidi Janssen6,8, Sandra G Brauer1. 1. 1 Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia. 2. 2 Allied Health Medical Services, Nambour General Hospital, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia. 3. 3 Sunshine Coast Clinical School, The University of Queensland, Nambour, QLD, Australia. 4. 4 Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada. 5. 5 Stroke Division, The Florey Institute of Neuroscience & Mental Health, Melbourne, VIC, Australia. 6. 6 NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, VIC, Australia. 7. 7 Nursing and Midwifery, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia. 8. 8 Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia.
Abstract
OBJECTIVES: To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute stroke patients and reduce adverse events. DESIGN: Controlled before-after pilot study. SETTING: An acute stroke unit in a regional Australian hospital. PARTICIPANTS: Acute stroke patients admitted during (a) initial usual care control period, (b) an enriched environment period and (c) a sustainability period. INTERVENTION: Usual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing and daily group activities. Change management strategies were used to implement an enriched environment within existing staffing levels. MAIN MEASURES: Behavioural mapping was used to estimate patient activity levels across groups. Participants were observed every 10 minutes between 7.30 am and 7.30 pm within the first 10 days after stroke. Adverse and serious adverse events were recorded using a clinical registry. RESULTS: The enriched environment group ( n = 30, mean age 76.7 ± 12.1) spent a significantly higher proportion of their day engaged in 'any' activity (71% vs. 58%, P = 0.005) compared to the usual care group ( n = 30, mean age 76.0 ± 12.8). They were more active in physical (33% vs. 22%, P < 0.001), social (40% vs. 29%, P = 0.007) and cognitive domains (59% vs. 45%, P = 0.002) and changes were sustained six months post implementation. The enriched group experienced significantly fewer adverse events (0.4 ± 0.7 vs.1.3 ± 1.6, P = 0.001), with no differences found in serious adverse events (0.5 ± 1.6 vs.1.0 ± 2.0, P = 0.309). CONCLUSIONS: Embedding an enriched environment in an acute stroke unit increased activity in stroke patients.
RCT Entities:
OBJECTIVES: To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute strokepatients and reduce adverse events. DESIGN: Controlled before-after pilot study. SETTING: An acute stroke unit in a regional Australian hospital. PARTICIPANTS: Acute strokepatients admitted during (a) initial usual care control period, (b) an enriched environment period and (c) a sustainability period. INTERVENTION: Usual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing and daily group activities. Change management strategies were used to implement an enriched environment within existing staffing levels. MAIN MEASURES: Behavioural mapping was used to estimate patient activity levels across groups. Participants were observed every 10 minutes between 7.30 am and 7.30 pm within the first 10 days after stroke. Adverse and serious adverse events were recorded using a clinical registry. RESULTS: The enriched environment group ( n = 30, mean age 76.7 ± 12.1) spent a significantly higher proportion of their day engaged in 'any' activity (71% vs. 58%, P = 0.005) compared to the usual care group ( n = 30, mean age 76.0 ± 12.8). They were more active in physical (33% vs. 22%, P < 0.001), social (40% vs. 29%, P = 0.007) and cognitive domains (59% vs. 45%, P = 0.002) and changes were sustained six months post implementation. The enriched group experienced significantly fewer adverse events (0.4 ± 0.7 vs.1.3 ± 1.6, P = 0.001), with no differences found in serious adverse events (0.5 ± 1.6 vs.1.0 ± 2.0, P = 0.309). CONCLUSIONS: Embedding an enriched environment in an acute stroke unit increased activity in strokepatients.
Authors: Matthew S Jeffers; Boris Touvykine; Allyson Ripley; Gillian Lahey; Anthony Carter; Numa Dancause; Dale Corbett Journal: J Neurosci Date: 2020-06-30 Impact factor: 6.167
Authors: Anna Palumbo; Viswanath Aluru; Jessica Battaglia; Daniel Geller; Alan Turry; Marc Ross; Adrian Cristian; Caitlin Balagula; Gbenga Ogedegbe; Latika Khatri; Moses V Chao; Robert C Froemke; Jacek K Urbanek; Preeti Raghavan Journal: Am J Phys Med Rehabil Date: 2021-12-06 Impact factor: 3.412
Authors: Ingrid C M Rosbergen; Sandra G Brauer; Sarah Fitzhenry; Rohan S Grimley; Kathryn S Hayward Journal: BMJ Open Date: 2017-12-21 Impact factor: 2.692