Evaluating the impact of a training program to support transitioning from the hospital to the community for people after stroke: a community case study

Shari Cooper,Michelle Lui,Marie-Louise Bird,Katherine McKellar,Janice J. Eng

doi:10.1186/s12913-021-07436-7

Abstract

BackgroundThe transitions in care along the stroke recovery path are challenging, particularly in finding mechanisms to continue one’s recovery once at home. We aim to evaluate the impact of training physiotherapists and fitness instructors from one regional community together to deliver an evidence-based group exercise program starting in the hospital and transitioning to the community using an implementation approach.MethodsThe evidenced based exercise program Fitness and Mobility Exercise (FAME) for stroke was chosen as the intervention. Data from interviews with stakeholders (community centre and health authority hospital staff including a physiotherapy navigator) was transcribed and themes evaluated using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. These data were supplemented by information collected as a quality assurance project within the health authority.ResultsTwo programs were established; one in the community centre (run over 15 months by fitness instructors) and one in the regional hospital (run over 12 months by a rehabilitation assistant under the direction from a physiotherapist). Transitions in care were facilitated by implementing the same evidence-based group exercise class in both the hospital and community setting, so people living with stroke could seamlessly move from one to another. An existing physiotherapist navigator service also was valued as a support for the transitions between the two centres for people with stroke. The hospital group accessed group-based physiotherapy service on average 31 days earlier than they were able to in a one-to-one format.ConclusionsThis case study described the implementation of the Fitness and Mobility Exercise (FAME) program in one community and the use of a physiotherapist navigator to assist transition between them. After a community training workshop, FAME programs were established within the health authority and the community centre. FAME program participants within the health authority benefited from reduced wait times to access hospital outpatient physiotherapy service. Improvements in function were measured in and reported by the people after stroke attending either the health authority or community centre FAME groups.

Highlights

The transitions in care along the stroke recovery path are challenging, in finding mecha‐ nisms to continue one’s recovery once at home
The purpose of this study is to evaluate the impact of training physiotherapists and fitness instructors from one community to deliver an exercise program for people after stroke starting in the hospital and transitioning to the community based on the Fitness and Mobility Exercise (FAME) program using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework [14]
A full-day workshop was delivered in September 2017 to teach the FAME Program to physiotherapists and fitness instructors

Summary

Introduction

The transitions in care along the stroke recovery path are challenging, in finding mecha‐ nisms to continue one’s recovery once at home. Stroke rehabilitation health professionals and people living with stroke have identified that transitions in care along the stroke recovery path are a major gap that needs. The transition from hospital to home requires coordination from multiple centres or units to support individuals as they continue their physical, cognitive, and emotional recovery at home. As one mechanism of continuing their recovery, people with stroke are encouraged to participate in evidence-based community exercise programs [2]. It is known that physical function and mobility are positively associated with physical activity [4] with evidence to show that communitybased group-exercise interventions improve and retain mobility, functional capacity, and balance [5]. Community-based group-exercise interventions motivate individuals to leave their homes; to connect socially; to establish structure and routine; to advance personal growth and development while supporting and influencing others to accomplish similar goals [6]. Sedentary time is prevalent following stroke [8] and is of great concern as it limits functional improvement and increases cardiovascular risk [9]

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