Abstract
BackgroundClinical practice guidelines advocate engaging stroke survivors in as much activity as possible early after stroke. One approach found to increase activity levels during inpatient rehabilitation incorporated an enriched environment (EE), whereby physical, cognitive, and social activity was enhanced. The effect of an EE in an acute stroke unit (ASU) has yet not been explored.Methods/designWe will perform a prospective non-randomized before-after intervention study. The primary aim is to determine if an EE can increase physical, social, and cognitive activity levels of people with stroke in an ASU compared to usual care. Secondary aims are to determine if fewer secondary complications and improved functional outcomes occur within an EE. We will recruit 30 people with stroke to the usual care block and subsequently 30 to the EE block. Participants will be recruited within 24–72 h after onset of stroke, and each block is estimated to last for 12 weeks. In the usual care block current management and rehabilitation within an ASU will occur. In the EE block, the ASU environment will be adapted to promote greater physical, social, and cognitive activity. Three months after the EE block, another 30 participants will be recruited to determine sustainability of this intervention. The primary outcome is change in activity levels measured using behavioral mapping over 12 h (7.30 am to 7.30 pm) across two weekdays and one weekend day within the first 10 days of admission. Secondary outcomes include functional outcome measures, adverse and serious adverse events, stroke survivor, and clinical staff experience.DiscussionThere is a need for effective interventions that starts directly in the ASU. The EE is an innovative intervention that could increase activity levels in stroke survivors across all domains and promote early recovery of stroke survivors in the acute setting.Trial registrationAustralian New Zealand Clinical Trial Registry, ANZCTN12614000679684
Highlights
Clinical practice guidelines advocate engaging stroke survivors in as much activity as possible early after stroke
Despite awareness of the positive effects of increased physical activity, available evidence indicates that stroke survivors spend the majority of the day physically inactive and alone early after stroke [5]
This study showed promising results, with increased activity levels demonstrated across these activity domains [15]
Summary
Clinical practice guidelines advocate engaging stroke survivors in as much activity as possible early after stroke. Despite awareness of the positive effects of increased physical activity, available evidence indicates that stroke survivors spend the majority of the day physically inactive and alone early after stroke [5]. Limited evidence is available regarding cognitive activity after stroke Cognitive activity such as listening to music during early recovery has been shown to enhance focused attention [11], lessen depressed mood [11], and improve visual attention in those with unilateral neglect [12]. Despite these possible benefits, little is known regarding social and cognitive activity levels in stroke survivors early after stroke
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