Community-based Stroke Rehabilitation Research Articles

Investigating the Implementation of Community-Based Stroke Telerehabilitation in England; A Realist Synthesis Study Protocol.

Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate how TR can be implemented to support the provision of high-quality, equitable community-based stroke rehabilitation, and under what conditions. Using a realist approach, we will synthesise information from (1) an evidence review, (2) qualitative interviews with clinicians (n ≤ 30), and patient-family carer dyads (n ≤ 60) from three purposively selected community stroke rehabilitation services in England. Working groups including rehabilitation professionals, service-users and policy-makers will co-develop actionable recommendations. Insights from the review and the interviews will be synthesised to test and refine programme theories that explain how TR works and for whom in clinical practice, and draw key messages for service implementation. This protocol highlights the need to improve our understanding of TR implementation in the context of multidisciplinary, community-based stroke service provision. We suggest the use of a realist methodology and co-production to inform evidence-based recommendations that consider the needs and priorities of clinicians and people affected by stroke.

Identifying Stroke Caregivers’ Coping Strategies: The Smile that has Struggled through the Tears-A Mixed-Method Research Approach

Background: Sudden stroke had caused the caregivers minimal time to prepare for their role as carers. Some stroke caregivers were overwhelmed to adjust and accept new responsibilities. They need to reorganise their functions and establish new daily life routines in response to the chronic illness that happens with stroke survivors.
 Objective: This study aimed to determine and explore coping strategies employed by stroke caregivers.
 Methods: This mixed-method study involved 32 stroke caregivers from a community-based stroke rehabilitation centre in Kuching, Sarawak. Results: From quantitative analysis, most stroke caregivers employed problem-focused coping strategies (mean=56.66, SD=10.79), followed by emotion-focused coping strategies (mean=55.63, SD=10.29) in confronting the challenges of caring for stroke survivors. Data from qualitative findings revealed eight themes of coping strategies: adjustment to daily life, selfmotivation, sharing with other people, acceptance, avoiding thinking about the problem, hoping stroke survivors will get better, emotion suppression and self-blame.
 Conclusion: This study’s outcomes provide crucial information about the burdens held by stroke caregivers when taking care of stroke survivors. Stroke caregivers need to adapt better and suitable coping strategies. This will prevent them from becoming overwhelmed by the accumulated stress from caring burdens. The long-term effect of coping strategies should positively assist stroke caregivers in managing the burdens effectively and fostering satisfaction in their life.
 Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 130-140

Psychoeducational Intervention for Family Caregiver Burden in Stroke Patients Care

Stroke rehabilitation is a long and complicated process that the majority of rehabilitation to be completed once the patient returns home (community-based stroke rehabilitation). A caregiver supports a stroke survivor in performing daily activities. Because of that responsibilities,caregiver feels physically and psychologically drained. The aim of this study was to find out the effects of psychoeducation on stroke patients' caregiver burden. The study used a purposive random sample technique with a total of 34 respondents to perform a quantitative study with a quasi-experimental design of two groups pre- and post-test in July 2021 in West Java. Zarit Burden Interview (ZBI) questionnaires were used to collect data of caregiving burden. The results of this study indicate that there was a significant difference between the intervention and control groups using the paired t-test (p=0.002) and a significant effect value utilizing the ANCOVA test (p=0.000). The Conclusion are Psychoeducation has a considerable impact on stroke patients' caregiver burden. In caring for stroke patients at home, a nurse can provide psychoeducation and caregiver supplies.

A Survey of Technologies Facilitating Home and Community-Based Stroke Rehabilitation

Stroke is a cardiovascular and cerebrovascular disease that affects the aged population at a high rate. Patients’ functional disabilities can be reduced with effective rehabilitation training. However, due to a lack of hospital resources and a social yearning for family contact, patients frequently discontinue rehabilitation training sessions and return home to their local community. Such a shift emphasizes the value of home and community-based rehabilitation, where patients can perform daily training with remote support from therapists. In this survey, the technologies that assist stroke rehabilitation will be discussed in following aspects: (1) technologies for home-based stroke rehabilitation; (2) technologies for community-based stroke rehabilitation; (3) technologies for therapist’s engagement in remote rehabilitation. A comprehensive overview of technologies that support home and community-based stroke rehabilitation was presented, as well as insights into future research themes.

An Exploratory Qualitative Study With Older Malaysian Stroke Survivors, Caregivers, and Healthcare Practitioners About Falls and Rehabilitation for Falls After Stroke.

Background: Studies on rehabilitation for falls after a stroke remain limited despite its impact being profound. This scenario justifies a deeper understanding of why falls in stroke rehabilitation received less attention. Current investigations on the perception of falls and stroke also proved inadequate. Therefore, this study aims to explore the perceptions and experiences of older Malaysian stroke survivors, spousal caregivers, and healthcare practitioners on falls in stroke rehabilitation.Method: A qualitative study of three focus groups with 18 individuals from one community-based stroke rehabilitation center was conducted. The discussions were audio-recorded, video-recorded, transcribed, summarized, and analyzed using thematic analysis.Results: Three themes emerged from the analysis: (i) perceived factors and consequences of falls after stroke, (ii) physical-based interventions predominate in rehabilitation for falls after stroke, and (iii) the role of home hazards in fall prevention is taken for granted. Although, awareness of falls is high, they are regarded as a peripheral issue in stroke. Rehabilitation interventions such as improved functionality are believed to be adequate and can indirectly prevent falls. Other interventions for fall prevention such as home hazards management are relatively less known.Conclusion: There is a need for more attention regarding home environment risk assessment and intervention among healthcare professionals, and more education for clients and caregivers is required. Although, other stroke interventions may also benefit stroke survivors, falls prevention should be a central component in stroke rehabilitation. As this study focused on a specific population, the findings should be validated with larger populations, and in diverse settings.

Abstract P209: Community-Based Outpatient Stroke Rehabilitation Program Achieves Excellent Return to Work Outcomes: Characteristics and Rehabilitation Outcomes of Stroke Survivors Who Return to Work

Background: Return to employment and driving are goals for many stroke survivors. There are few reports of patient centered outcomes like return to work or the characteristics of those who achieve these goals. Methods: Prospective observational study of stroke patients treated between 12/2011-7/2019 in an interdisciplinary outpatient rehabilitation program addressing physical, cognitive/communicative, risk factors, psychosocial, driving and vocational issues. Results: Of 190 consecutive patients,104(55%) were working prior to their stroke. 50% (73% men, 27% women) of those working pre-stroke returned to work upon program completion with 90% returning to their prior job, and 65% at prior hours. 24% of returning workers owned their own business, and 76% had other occupations. Returning workers had average age of 54 years, average NIHSS score of 4(range 0-11), average{mRS} of 2.7 (6% with 1; 25% with 2; 58% with 3; 10% with 4), and 31% were aphasic. 39 suffered ischemic strokes and 13 had hemorrhages. Locations were: 18 Left, 15 Right,11 Bilateral hemisphere, 8 Brainstem). 93% of patients working pre-stroke were driving. 80% who returned to work also resumed driving. Returning workers had average percent improvement in 6” walk and Berg Balance scores of 97% and 50% respectively; this group also improved in all 9 Stroke Impact scale domains with SIS total score improving an average of 22%. In comparison, of those not returning to work 34 had ischemic strokes, 18 had hemorrhages. This group had average age 55.6, average NIHSS score 7.3(range2-16), average {mRS} of 3.3(11% with 2, 54% with 3, 33% with 4, 2% with 5), 42% were aphasic, and 20% resumed driving. Returning workers had average admit Montreal Cognitive Assessment score of 25/30 and Stroke Self Efficacy Score of 85%; with average scores of 21/30 and 71% for those not returning to work. Average length of stay was 4.6(range .5-24) and 7.4(range1.7-18) months for those returning and not returning to work. Other demographic and outcome measures are collected. Conclusions: Despite significant disability, stroke survivors can achieve successful recovery, including return to work and driving. Further study of patients returning to work can help direct rehabilitation efforts for patients with return to work goals.

Inclusion of stroke patients in expanded cardiac rehabilitation services: a cross-national qualitative study with cardiac and stroke rehabilitation professionals

Purpose This qualitative study explored healthcare professionals’ views in relation to the potential expansion of cardiac rehabilitation services to include stroke patients, thereby becoming a cardiovascular rehabilitation model. Design and methods 23 semi-structured interviews were completed with hospital and community-based stroke and cardiac rehabilitation professionals in Switzerland (n = 7) and Ireland (n = 19). The sample comprised physiotherapists, occupational therapists, speech and language therapists, stroke physicians, cardiologists, psychologists, dieticians and nurses. Interviews were audio-recorded and the transcripts were analysed in NVivo using inductive Thematic Analysis. Results Barriers and facilitators to cardiovascular rehabilitation were captured under four broad themes; (i) Cardiac rehabilitation as “low-hanging fruit,” (ii) Cognitive impairment (“the elephant in the room”), (iii) Adapted cardiac rehabilitation for mild stroke, and (iv) Resistance to change. Conclusions Hybrid cardiac rehabilitation programmes could be tailored to deliver stroke-specific education, exercises and multidisciplinary expertise. Post-stroke cognitive impairment was identified as a key barrier to participation in cardiac rehabilitation. A cognitive rehabilitation intervention could potentially be delivered as part of cardiac rehabilitation, to address the cognitive needs of stroke and cardiac patients. Implications for rehabilitation The cardiac rehabilitation model has the potential to be expanded to include mild stroke patients given the commonality of secondary prevention needs. Up to half of stroke survivors are affected by post-stroke cognitive impairment, consequently mild stroke patients may not be such an “easy fit” for cardiac rehabilitation. A cardiovascular programme which includes common rehabilitation modules, in addition to stroke- and cardiac-specific content is recommended. A cognitive rehabilitation module could potentially be added as part of the cardiac rehabilitation programme to address the cognitive needs of stroke and cardiac patients.

Abstract WP188: Community-Based Outpatient Stroke Rehabilitation Program Achieves Excellent Outcomes Including Return to Work, Driving, Stroke Knowledge, and Other Rehabilitation Outcomes

Background: Return to driving and employment are goals for many stroke survivors. There are few reports of patient centered outcomes including return to employment, driving, self-efficacy, functional outcomes, stroke knowledge or characteristics of survivors who achieve these goals. Methods: Prospective observational study of stroke patients treated in an interdisciplinary outpatient rehabilitation program addressing physical, cognitive, communicative, risk factor/stroke knowledge, self-efficacy, psychosocial, driving and vocational issues. Results: 190 consecutive patients(117 men, 73 women, average age 62(18-90), 66 aphasic) with baseline modified Rankin Scores of 5(1%); 4(25%); 3(56%); 2(15%); 1(3%), and average NIHSS score of 6(range 0-18) were treated between 12/2011-7/2019. 136 Patients suffered ischemic strokes and 54 had hemorrhages. Locations were: 65 left, 69 right, 26 bilateral hemisphere, 30 brainstem. 41% had MCA territory strokes. Of 104 patients working pre-stroke, 50% returned to work and an additional 7% were work capable upon completion of program. 95% of patients driving pre-stroke could not drive on admission. After training, 43%(67/157) returned to driving. Patients had improvements in all 9 domains of Stroke Impact Scale with SIS total score improving an average of 23%. Patients received an average of 33 physical therapy visits with average percent improvement of 72% and 41% on 6” walk and Berg Balance scores. Average percent improvement in Stroke Self Efficacy Scores was 29%. After individualized cardiovascular risk, stroke and medication education sessions with the Nurse Practitioner based on AHA guidelines and Life’s Simple 7’s curriculum, stroke and risk factor knowledge quiz scores improved an average of 29%. Average length of stay was 5(range .5-24) months. Multiple other demographic and outcome measures are collected. Conclusions: Outcome data show a community-based team rehabilitation program can successfully combine CV/stroke education with rehabilitation services to maximize patient centered outcomes including return to work, driving, overall stroke recovery, physical functioning, stroke knowledge, and self-efficacy for many types of stroke survivors with moderate to severe disability.

Balance Confidence Is Related to Features of Balance and Gait in Individuals with Chronic Stroke

Reduced balance confidence is associated with impairments in features of balance and gait in individuals with subacute stroke. However, an understanding of these relationships in individuals at the chronic stage of stroke recovery is lacking. This study aimed to quantify the relationships between balance confidence and specific features of balance and gait in individuals with chronic stroke. Participants completed a balance confidence questionnaire and clinical balance assessment (quiet standing, walking, and reactive stepping) at 6 months postdischarge from inpatient stroke rehabilitation. Regression analyses were performed using balance confidence as a predictor variable, and quiet standing, walking, and reactive stepping outcome measures as the dependent variables. Walking velocity was positively correlated with balance confidence, whereas mediolateral center of pressure excursion (quiet standing) and double support time, step width variability, and step time variability (walking) were negatively correlated with balance confidence. This study provides insight into the relationships between balance confidence and balance and gait measures in individuals with chronic stroke, suggesting that individuals with low balance confidence exhibited impaired control of quiet standing as well as walking characteristics associated with cautious gait strategies. Future work should identify the direction of these relationships to inform community-based stroke rehabilitation programs for individuals with chronic stroke, and determine the potential utility of incorporating interventions to improve balance confidence into these programs.

The stroke impact scale: performance as a quality of life measure in a community-based stroke rehabilitation setting

Purpose: The objective of this study was to assess the psychometric properties of the Stroke Impact Scale (SIS). Methods: Data was derived from a study assessing a community-based stroke rehabilitation program. Patients were administered the SIS and Euroqol-5D (EQ-5D-5L) on admission to the study, and at six month and 12 month follow-up. The psychometric performance of each domain of the SIS was assessed at each time point. Results: A total of 164 patients completed outcome measures at baseline, 108 patients at six months and 37 patients at 12 months. Correlation of the SIS domains with the EQ-5D-5L suggested that the dimensions of health contributing to a patient’s perception of health-related quality of life changes over time. Conclusion: The SIS performed well in a sample of patients undergoing stroke rehabilitation in the community. Our findings suggest that the multidimensionality of the SIS may allow health professionals to track patient progress and tailor rehabilitation interventions to target the dimensions of health that are most important to a patient’s overall health and perceived quality of life over time.Implications for RehabilitationThere is an increased need for valid and reliable measures to evaluate the outcomes of patients recovering from stroke in the community.The Stroke Impact Scale (SIS) measures multiple domains of health and is well-suited for use in patients recovering from stroke in the community.There is a high level of internal consistency in the eight SIS domains with no evidence of floor effects; ceiling effects were noted for several domains.Correlation of the SIS with the Euroqol-5D suggested that the dimensions of health contributing to a patient’s perception of health related quality of life changes over time.

Visual search training in occupational therapy – an example of expert practice in community-based stroke rehabilitation

Introduction Visual searching is an essential component of many everyday activities. Search training is practised as part of occupational therapy to improve performance skills both in people with hemianopia and those with spatial inattention post stroke. Evaluation of the effectiveness of such training first requires a systematic and detailed description of the intervention. To this end, this study describes the practice of a specialist occupational therapist. Method Single sessions of intervention delivered by the occupational therapist to five participants with visual search disorders post stroke were video recorded. The recordings were analysed for content using a framework approach. Results The occupational therapist educated participants about the impact of their visual impairment on everyday activities. She used instructions, spatial cueing, placement of objects and verbal feedback to train increased amplitudes of eye and head movements, to direct attention into the blind field or neglected space and to encourage systematic searching during occupations and activities. Activities were graded by manipulating the area for attention and complexity in the environment. Conclusion This investigation provides a detailed description of a specialist occupational therapist’s community-based intervention for improving visual search post stroke.

Outcome Measure Use in Community-Based Stroke Rehabilitation: Survey of Therapists' Current Practice in Scotland

Outcome Measure Use in Community-Based Stroke Rehabilitation: Survey of Therapists' Current Practice in Scotland

Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey

Purpose: We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. Methods: We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. Results: Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n = 335/407) and provided input to a mixed diagnostic group of patients (71%; n = 312/437). Ninety one percent of services (n = 358/395) reported setting goals with “all” or “most” stroke survivors. Seventeen percent (n = 65/380) reported that no methods were used to guide goal setting practice; 47% (n = 148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n = 362/369) reported routinely asking patients about goal priorities; 39% (n = 141/360) reported routinely providing patients with a copy of their goals. Conclusions: Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist.Implications for RehabilitationCommunity-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients.Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal.Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.

Exploring views on long term rehabilitation for people with stroke in a developing country: findings from focus group discussions

BackgroundThe importance of long term rehabilitation for people with stroke is increasingly evident, yet it is not known whether such services can be materialised in countries with limited community resources. In this study, we explored the perception of rehabilitation professionals and people with stroke towards long term stroke rehabilitation services and potential approaches to enable provision of these services. Views from providers and users are important in ensuring whatever strategies developed for long term stroke rehabilitations are feasible and acceptable.MethodsFocus group discussions were conducted involving 15 rehabilitation professionals and eight long term stroke survivors. All recorded conversations were transcribed verbatim and analysed using the principles of qualitative research.ResultsBoth groups agreed that people with stroke may benefit from more rehabilitation compared to the amount of rehabilitation services presently provided. Views regarding the unavailability of long term rehabilitation services due to multi-factorial barriers were recognised. The groups also highlighted the urgent need for the establishment of community-based stroke rehabilitation centres. Family-assisted home therapy was viewed as a potential approach to continued rehabilitation for long term stroke survivors, given careful planning to overcome several family-related issues.ConclusionsBarriers to the provision of long term stroke rehabilitation services are multi-factorial. Establishment of community-based stroke rehabilitation centres and training family members to conduct home-based therapy are two potential strategies to enable the continuation of rehabilitation for long term stroke survivors.

Systematic Review of Leisure Therapy and Its Effectiveness in Managing Functional Outcomes in Stroke Rehabilitation

Background: Evidence suggests that the incorporation of leisure activities in adult stroke rehabilitation can contribute to improved physical, cognitive, and psychological outcomes. However, differences in study design and treatment delivery may affect these findings. Furthermore, the magnitude of therapeutic change associated with leisure therapy is unclear, with few quantitative reviews available. Objective: To synthesize and evaluate the empirical evidence examining leisure therapy in stroke rehabilitation. Methods: Eight independent studies (N = 615 participants) were identified from a comprehensive database search. Study quality was evaluated using the Oxford Levels of Evidence. Pre- and posttreatment data for participants who received leisure therapy, in comparison with peers who received standard care or no treatment, were evaluated by calculating Cohen’s d effect sizes and 95% confidence intervals. Results: No studies met the criteria for the highest level of methodological rigor, although all used randomization procedures. Leisure therapy contributed to significant short-term improvements in psychological outcomes, namely quality of life and mood (d range, 2.10 to 0.54), in addition to leisure-specific outcomes, including increased participation in and satisfaction with leisure activities (d range, 0.81 to 1.23). Longer term effects of treatment could not be determined, with one study providing data and reporting nonsignificant effects (d range, -0.07 to 0.17). Conclusions: There is some evidence that leisure therapy offers an opportunity to enhance short-term treatment gains in community-based stroke rehabilitation. Further controlled research is needed to establish its longer term effects and assist the development of evidence-based guidelines for this treatment.

Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation

BackgroundGoal setting is considered ‘best practice’ in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning & coping planning and appraisal & feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke.MethodsG-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation.ResultsG-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: (i) health professionals were concerned about the impact of goal non-attainment on patient’s well-being (patients did not share their concerns), and (ii) some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process.ConclusionsG-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings.

Interprofessional Stroke Rehabilitation for Stroke Survivors Using Home Care

To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services. Randomized controlled trial of 101 community-living stroke survivors (<18 months post-stroke) using home care services. Subjects were randomized to intervention (n=52) or control (n=49) groups. The intervention was a 12-month specialized, evidence-based rehabilitation strategy involving an interprofessional team. The primary outcome was change in health-related quality of life and functioning (SF-36) from baseline to 12 months. Secondary outcomes were number of strokes during the 12-month follow-up, and changes in community reintegration (RNLI), perceived social support (PRQ85-Part 2), anxiety and depressive symptoms (Kessler-10), cognitive function (SPMSQ), and costs of use of health services from baseline to 12 months. A total of 82 subjects completed the 12-month follow-up. Compared with the usual care group, stroke survivors in the intervention group showed clinically important (although not statistically significant) greater improvements from baseline in mean SF-36 physical functioning score (5.87, 95% CI -3.98 to 15.7; p=0.24) and social functioning score (9.03, CI-7.50 to 25.6; p=0.28). The groups did not differ for any of the secondary effectiveness outcomes. There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant (p=0.76). A 12-month specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care. Clinicaltrials.gov identifier: NCT00463229.

Increasing delivery of an outdoor journey intervention to people with stroke: A feasibility study involving five community rehabilitation teams

BackgroundContrary to recommendations in a national clinical guideline, baseline audits from five community-based stroke rehabilitation teams demonstrated an evidence-practice gap; only 17% of eligible people with stroke were receiving targeted rehabilitation by occupational therapists and physiotherapists to increase outdoor journeys. The primary aim of this feasibility study was to design, test, and evaluate the impact of an implementation program intended to change the behaviour of community rehabilitation teams. A secondary aim was to measure the impact of this change on client outcomes.MethodsA before-and-after study design was used. The primary data collection method was a medical record audit. Five community rehabilitation teams and a total of 12 professionals were recruited, including occupational therapists, physiotherapists, and a therapy assistant. A medical record audit was conducted twice over 12 months (total of 77 records pre-intervention, 53 records post-intervention) against a guideline recommendation about delivering outdoor journey sessions to people with stroke. A behavioural intervention (the 'Out-and-About Implementation Program') was used to help change team practice. Active components of the intervention included feedback about the audit, barrier identification, and tailored education to target known barriers. The primary outcome measure was the proportion of medical records containing evidence of multiple outdoor journey sessions. Other outcomes of interest included the proportion of medical records that contained evidence of screening for outdoor journeys and driving by team members, and changes in patient outcomes. A small sample of community-dwelling people with stroke (n = 23) provided pre-post outcome data over three months. Data were analysed using descriptive statistics and t-tests.ResultsMedical record audits found that teams were delivering six or more outdoor journeys to 17% of people with stroke pre-intervention, rising to 32% by 12 months post-intervention. This change represents a modest increase in practice behaviour (15%) across teams. More people with stroke (57%) reported getting out of the house as often as they wanted after receiving the outdoor journey intervention compared to 35% one year earlier; other quality of life outcomes also improved.ConclusionsThe 'Out-and-About Implementation Program' helped rehabilitation teams to change their practice, implement evidence, and improve client outcomes. This behavioural intervention requires more rigorous evaluation using a cluster randomised trial design.

Telerehabilitation - a new model for community-based stroke rehabilitation.

Community resources for stroke clients are underdeveloped in Hong Kong and stroke survivors often face difficulties in community reintegration. We have examined the feasibility of using videoconferencing for community-based stroke rehabilitation. The sample comprised 21 stroke patients living at home. All the subjects participated in an eight-week intervention programme at a community centre for seniors. The intervention, which comprised educational talks, exercise and psychosocial support, was conducted by a physiotherapist via a videoconference link. The Berg Balance Scale (BBS), State Self-Esteem Scale (SSES), Medical Outcomes Study 36-item Short Form (SF-36) and a stroke knowledge test were administered at the start and end of the programme. In addition, at the start of the study the Geriatric Depression Scale 15-item Short Form, the Elderly Mobility Scale and the Lawton Instrumental Activities of Daily Living Scale were used to assess subjects' baseline status, and a focus group was also held at the end of the programme to gather qualitative findings. Nineteen subjects completed the eight-week intervention. The baseline functional status was high, although 52% had symptoms of depression. After the intervention, there were significant improvements in BBS, SSES and knowledge test scores and scores on all subscales of the SF-36. All the subjects accepted the use of videoconferencing for delivery of the intervention. The pilot study demonstrated the feasibility, efficacy and high level of acceptance of telerehabilitation for community-dwelling stroke clients.