Stroke Rehabilitation Unit Research Articles

Abstract 22: Implementation of increased physical therapy intensity for improving walking across inpatient stroke rehabilitation units: Primary results of the Walk ‘n Watch multi-site stepped-wedge cluster randomized controlled trial

Introduction: Though clinical practice guidelines support high repetitions of walking after stroke, practice is slow to change with low levels of walking activity in stroke rehabilitation units. We undertook an implementation trial to change practice; we enabled entire stroke units to use the Walk ‘n Watch protocol and determined the effect of implementation on the 6 Minute Walk Test (6MWT) at hospital discharge. Methods: This 12-site clinical trial across 7 Canadian provinces used a stepped-wedge cluster design to randomize when each site switched from Usual Care to the Walk ‘n Watch protocol. At the start of the Walk ‘n Watch phase, we trained all front-line physical therapists on the unit with training workshops, manuals, hands-on practice, and videos. Each site was provided onboarding materials to address staff changes so therapists who did not attend the initial training could adopt the protocol. Each site also identified a ‘protocol champion’ to facilitate initial weekly huddles with therapists to discuss barriers to implementation. Therapists were trained to complete safety screening and to determine eligibility. The Walk ‘n Watch protocol focused on completing a minimum of 30-minutes of daily weight-bearing, walking-related activities that progressively increased in intensity informed by activity trackers measuring heart rate and step number. Blinded assessors completed the outcomes at baseline and 4-weeks later (near discharge). Primary analysis used a linear mixed-effects model adjusted for stratum, date of enrollment, age, sex and baseline 6MWT. Results: The total number of participants was 306 (162 Usual Care, 144 Walk ‘n Watch, 188 males/118 females) with a mean(SD) age of 68(13), 29(17) days since stroke, and a baseline 6MWT of 152(106) m. The improvement on the 6MWT was 43.6m (95%CI 12.7, 76.1) greater in the Walk ‘n Watch group compared to the Usual Care group. Further, the Walk ‘n Watch group improved quality of life (EQ5D), balance and mobility (Short Physical Performance Battery) and gait speed. Conclusions: The implementation trial design enabled the protocol to be tested under real-world conditions, involving all therapists on each unit to deliver the protocol. The trial had a deliberate aim to facilitate changes in practice that resulted in clinically meaningful improvements in walking and quality of life.

Evaluating the implementation of “Productive Ward: releasing time to care” in a rehabilitation and acute stroke unit: a quality improvement program

Evaluating the implementation of “Productive Ward: releasing time to care” in a rehabilitation and acute stroke unit: a quality improvement program

Observation of the rate of skin breakdown and pain secondary to prefabricated ankle foot orthosis usage during gait training in an inpatient stroke rehabilitation unit

Observation of the rate of skin breakdown and pain secondary to prefabricated ankle foot orthosis usage during gait training in an inpatient stroke rehabilitation unit

Exploring physiotherapy staff’s perceptions of physiotherapy delivery in acute stroke rehabilitation

Objective To explore physiotherapists’ perspectives on current and alternative models of physiotherapy delivery in acute stroke rehabilitation. Design Qualitative service evaluation Setting An acute stroke rehabilitation unit within a London teaching hospital in the UK. Participants A purposive sample of 17 physiotherapy staff (qualified physiotherapists and physiotherapy support staff) working in the acute stroke rehabilitation unit at the time of, or in the previous 3 months of the study were recruited to participate. Results Three themes were identified: barriers to effective physiotherapy delivery, enablers of effective physiotherapy delivery, and alternative models of physiotherapy delivery. Themes were framed by the concept of providing effective and efficient physiotherapy guided by reflection. Main barriers included patients not being ready for and underutilisation of time within physiotherapy sessions. Use of timetabling and access to senior therapy support enabled more effective and efficient physiotherapy delivery. Alternative models to optimise physiotherapy delivery included different staff to patient ratios, group therapy, opportunistic physiotherapy delivery and self-management. Conclusions Several enablers of and barriers to providing effective and efficient physiotherapy post-stroke exist. Physiotherapists should consider implementing alternative models of physiotherapy delivery to increase the amount of physiotherapy provided to patients’ post-stroke, thereby facilitating post-stroke functional recovery.

Nurses' Descriptions of Interdisciplinary Interactions in Stroke and Geriatric Rehabilitation Units: A Case Example of the Registered Practical Nurse.

To analyse how nurses describe their interactions with other interdisciplinary team members within stroke and geriatric rehabilitation. A secondary analysis of cross-sectional ethnographic interview data was conducted using Elo and Kyngäs' (2008) deductive content analysis. Between April 12 and July 25, 2022, semi-structured interviews were conducted with 31 registered practical nurses recruited through convenience sampling from three tertiary hospital sites in Southwestern Ontario. Interview transcripts were reviewed to identify described interactions between nurses and interdisciplinary team members and were coded for: who were the interdisciplinary team member(s) involved; what content was addressed; and where, when, and why the interaction occurred. Categories representing how nurses describe their interactions with interdisciplinary team members were as follows: (1) arising from the unique roles owned by either the nurse or interdisciplinary team member(s); (2) requiring open communication to achieve patient goals and improve patient care; (3) occurring within what is perceived to be either the therapists' or nurses' physical space; and (4) contributing to supportive team environments that are mutually beneficial. While nurses view other interdisciplinary team members as 'owning' certain roles and physical spaces within rehabilitation, they also recognised their 'owned' spaces and roles. Unique contributions of all team members were valued as necessary to provide holistic, person-centred patient care and positive team-based support. Nurses' descriptions of their interactions with interdisciplinary team members demonstrated their essential contributions to team-based patient care and acknowledged nurse contributions to the rehabilitation process for patients. Findings elucidate the nature of interprofessional interactions and 'ownership' within the rehabilitation process. Results are beneficial for policymakers, educators, and healthcare organisations aiming to optimise the nursing role within rehabilitation spaces. The Consolidated Criteria for Reporting Qualitative Research Checklist (COREQ). No patient or public contribution.

Assessing actigraphy performance for daytime sleep detection following stroke: insights from inpatient monitoring in a rehabilitation hospital.

Stroke can result in or exacerbate various sleep disorders. The presence of behaviors such as daytime sleepiness poststroke can indicate underlying sleep disorders which can significantly impact functional recovery and thus require prompt detection and monitoring for improved care. Actigraphy, a quantitative measurement technology, has been primarily validated for nighttime sleep in healthy adults; however, its validity for daytime sleep monitoring is currently unknown. Therefore this study aims to identify the best-performing actigraphy sensor and algorithm for detecting daytime sleep in poststroke individuals. Participants wore Actiwatch Spectrum and ActiGraph wGT3X-BT on their less-affected wrist, while trained observers recorded daytime sleep occurrences and activity levels (active, sedentary, and asleep) during non-therapy times. Algorithms, Actiwatch (Autoscore AMRI) and ActiGraph (Cole-Kripke, Sadeh), were compared with on-site observations and assessed using F2 scores, emphasizing sensitivity to detect daytime sleep. Twenty-seven participants from an inpatient stroke rehabilitation unit contributed 173.5 hours of data. The ActiGraph Cole-Kripke algorithm (minute sleep time = 15 minutes, bedtime = 10 minutes, and wake time = 10 minutes) achieved the highest F2 score (0.59). Notably, when participants were in bed, the ActiGraph Cole-Kripke algorithm continued to outperform Sadeh and Actiwatch AMRI, with an F2 score of 0.69. The study demonstrates both Actiwatch and ActiGraph's ability to detect daytime sleep, particularly during bed rest. ActiGraph (Cole-Kripke) algorithm exhibited a more balanced sleep detection profile and higher F2 scores compared to Actiwatch, offering valuable insights for optimizing daytime sleep monitoring with actigraphy in stroke patients.

Cost-Effectiveness Analysis of Rehabilitation Methods for Stroke Survivors

Background: One of the challenges in stroke management is how to provide rehabilitation services to stroke patients in Iran. Objectives: This study aimed to evaluate and compare the cost-effectiveness of rehabilitation interventions for stroke patients in three settings: Hospitals, stroke units, and homes. Methods: This cross-sectional study was conducted from the perspective of the health system. A Markov model with a 20-year time horizon and 3-month cycles was used to analyze costs and outcomes. Cost data were collected from 210 patients undergoing rehabilitation in hospitals, homes, or stroke units. The cost-effectiveness analysis (CEA) was conducted by calculating the incremental cost-effectiveness ratio (ICER) using Tree Age software. Results: The average rehabilitation cost for the home strategy ($2306 ± 35.018) was less than that for the hospital ($2955 ± 48.18) and stroke unit ($3485 ± 51.63) strategies. Furthermore, the QALY of the home strategy (26.03) was 8 times higher than that of the hospital (17.99) and 19 times higher than that of the stroke unit (7.03). The average cost-effectiveness ratios for the hospital, stroke unit, and home groups were $11424, $33159, and $7233 per QALY, respectively. The ICERs for stroke unit and home rehabilitation relative to hospital rehabilitation were $2517 and $2145 per QALY, respectively. Conclusions: According to the results, the home-based rehabilitation strategy is more cost-effective than hospital and stroke unit rehabilitation strategies. Given the high rates of stroke and its associated costs in Iran, it is suggested that policymakers lay the groundwork for providing these services at home.

Analysis of the impact of integrated traditional Chinese and western medicine rehabilitation stroke units on the recovery of patients with hemiplegia during the recovery period of stroke.

Analysis of the impact of integrated traditional Chinese and western medicine rehabilitation stroke units on the recovery of patients with hemiplegia during the recovery period of stroke.

Lateropulsion resolution and outcomes up to one year post-stroke: a prospective, longitudinal cohort study

ABSTRACT Background Post-stroke lateropulsion is prevalent and associated with poor rehabilitation outcomes; however, data regarding long-term function associated with lateropulsion are lacking. Objectives This study aimed to explore lateropulsion resolution and associations between lateropulsion, functional outcomes, and fall occurrence up to 12 months post-stroke. Methods Participants for this prospective, longitudinal cohort study were recruited from a Stroke Rehabilitation Unit (SRU). Assessments were conducted at SRU admission, at discharge, and at three, six, nine, and twelve months post-stroke. Outcomes included the Four-Point Pusher Score (4PPS), Functional Independence Measure (FIM), and fall occurrence. Longitudinal outcomes were modeled using generalized linear mixed-effects models. Results The final analyses included data from 144 participants. Eighty-two participants (56.9) had lateropulsion (4PPS ≥ 1) on admission. Odds of resolved lateropulsion (4PPS = 0) increased longitudinally from discharge for people who participated in rehabilitation physiotherapy (OR: 9.7, 28.1, 43.1, 81.3: <0.001 at three, six, nine, and twelve months respectively). The greatest FIM improvement among participants in all 4PPS categories occurred during the SRU inpatient phase. The probability of falls post-discharge was greatest among participants with 4PPS = 1 at three months, when compared with 4PPS = 0 (p= 0.022). Conclusions This study showed that lateropulsion can continue to resolve up to one year post-stroke. Earlier lateropulsion resolution was associated with ongoing rehabilitation physiotherapy participation. Long-term functional gains were maintained among people discharged home, whereas functional status deteriorated after six months among those in residential care. Study findings will allow rehabilitation and service providers to better plan for and accommodate the long-term rehabilitation and care needs of people with post-stroke lateropulsion.

Stroke Inpatient Rehabilitation Environments: Aligning Building Construction and Clinical Practice Guidelines Through Care Process Mapping.

Stroke inpatient rehabilitation is a complex process involving stroke survivors, staff, and family utilizing a common space for a shared purpose: to optimize recovery. This complex pathway is rarely fully described. Stroke care is ideally guided by Clinical Practice Guidelines, and the rehabilitation built environment should serve to optimize care delivery, patient and staff experience. We aimed to articulate the inpatient stroke rehabilitation process of care in a series of process maps, and to understand the degree to which current stroke clinical and building construction (ie, design) guidelines align to support inpatient stroke rehabilitation. We used the Value-Focused Process Engineering methodology to create maps describing the events and activities that typically occur in the current stroke inpatient rehabilitation service model. These maps were completed through individual and group session consultations with stroke survivors, architects, policy makers, and clinical experts. We then determined which sections of the Australian Stroke Rehabilitation Guidelines and the Australasian Health Facility Design Guidelines could be aligned and applied to the process maps. We present a summary process map for stroke inpatient rehabilitation, alongside detailed process maps for 4 different phases of rehabilitation (admission, a normal weekday, a weekend day, and discharge) using Value-Focused Process Engineering notation. The integration of design and clinical guidelines with care pathway maps revealed where guidelines lack detail to be readily linked to current stroke inpatient care practice, providing an opportunity to design stroke inpatient rehabilitation spaces based on the activities occurring within them. Our findings highlight gaps where clinical and design experts should work together to use guidelines to their full potential; and to improve the process of planning for future stroke rehabilitation units.

304 Increasing the intensity of physiotherapy in a subacute stroke rehabilitation unit—results of audit and intervention

Abstract Background The National Clinical Guideline for Stroke (2023) recommend the delivery of high intensity therapy to optimise physical recovery post-stroke. Previous guidelines suggested 45 minutes but now suggest a total of 3 hours daily. The aim of this intervention was to review current practice and implement the stroke guidelines aiming to augment the dosage of therapy sessions. Methods Given the guidelines’ recommendation to improve the reporting of exercise prescription, a chart audit was completed comparing the dosage of physiotherapy from 2020–2022 on a random sample of 10 charts per year. Strategies to increase intensity included a restructure of the stroke exercise class, run twice weekly. The class structure moved towards a circuit class of 5x 6-minute stations followed by group outdoor mobility. Use of tally counters, increased semi-supervised practice and introduction of a ‘champions board’ to celebrate individuals’ achievements also contributed to a culture of high intensity therapy. Results The chart audit showed an improvement in the recording of repetitions each year. The average recorded repetitions per week for stroke survivors increased from 77.9 repetitions in 2020 to a weekly average of 1,043 in 2022 (2020 range 0–288 repetitions; 2022 range 245–2095 repetitions). The average repetitions in the stroke exercise class in 2022 was 462 and was previously not measured. A review of annual patient statistics from 2021 and 2022 showed that stroke survivors spent more time in physiotherapy in 2022. This was likely affected by variables such as staffing allocation and COVID-19 restrictions limiting the ability to provide gym-based therapy or group classes. Conclusion The measurement and recording of intensity has improved and increased in 2022 although this may have been affected by factors outside of this intervention. Future iterations of this project would be to increase dosage of upper limb therapy, and to increase physical activity outside therapy, such as use of pedometers outside therapy hours.

Comparing stroke rehabilitation inpatients and clinical trials eligibility criteria: A secondary chart review analysis revealing that most patients could have been excluded from rehabilitation trials based on comorbidity status

Background The generalizability of treatments examined in rehabilitation randomized controls trials (RCTs) partly depend on the similarity between trial subjects and a stroke rehabilitation inpatient population. The aim of this study was to determine the proportion of stroke rehabilitation inpatients that would have been eligible or ineligible to participate in published stroke RCTs. Methods This was a secondary analysis of chart review data collected as part of an independent quality improvement initiative. Data pertaining to the characteristics of stroke rehabilitation inpatients (e.g. age, cognitive impairment, previous stroke, comorbidities) were extracted from the medical charts of patients consecutively admitted to an inpatient stroke rehabilitation unit at a large urban rehabilitation hospital in Canada. Using the exclusion criteria categories of stroke RCTs identified from a systematic scoping review of 428 RCTs, we identified how many stroke rehabilitation inpatients would have been eligible or ineligible to participate in stroke RCTs based on their age, cognitive impairment, previous stroke and presence of comorbidities. Results In total, 110 stroke rehabilitation inpatients were included. Twenty-four percent of patients were 80 years of age or older, 84.5% had queries or concerns regarding patient cognitive abilities, 28.0% had a previous stroke, and 31.8% had a severe stroke. Stroke rehabilitation inpatients had six comorbidities on average. Based on these factors, most stroke rehabilitation inpatients could have been excluded from stroke RCTs, with cognitive impairment the most common RCT exclusion criteria. Conclusions Changes to the design of RCTs would support the development of clinical practice guidelines that reflect stroke rehabilitation inpatient characteristics, enhancing equity, diversity, and inclusion within samples and the generalizability of results.

Treating Visual Inattention in Acute Stroke Survivors Using a Therapy Scanning Wall: A Proof-of-Concept Study.

Visual inattention is common following right hemisphere stroke, with up to 80% of patients being affected. Visual inattention following stroke is linked to poorer outcomes. There is no clear evidence for how visual inattention should be treated in the hospital inpatient setting. To explore the practical implications and possible benefits of using a visual scanning wall in a stroke rehabilitation unit as an assessment and treatment tool for visual inattention. This proof-of-concept study recruited stroke survivors with visual inattention. Participants used the scanning wall for scanning training five days a week for two weeks. Assessments using the scanning wall and modified Albert's test were conducted at baseline and at day 14. Both participants and staff delivering the training were asked to complete an acceptability questionnaire. All participants demonstrated an improvement in the number of pictures identified from baseline to day 14. There was a mean improvement of 9.20 (95% CI 4.77 to 13.63) in the 14 days. This is a statistically significant improvement in the scanning wall score between baseline line and day 14 (p = 0.01). All participants and staff reported the scanning wall as acceptable to use. This proof-of-concept study has demonstrated the scanning wall could be used to assess for visual inattention in extra personal space. Also, it could be beneficial and is acceptable for the treatment of visual inattention within a hospital inpatient setting for acute stroke survivors.

The Role and Contributions of Nurses in Stroke Rehabilitation Units: An Integrative Review.

Nurses' contributions to stroke rehabilitation have been viewed as pivotal, but therapeutically nonspecific. This integrative review synthesized empirical literature on the roles and contributions of nurses to inpatient stroke rehabilitation to answer three research questions: (a) What specific skills or tasks have been identified as the roles and contributions of nurses to inpatient stroke rehabilitation? (b) How do nurses perform these skills/tasks to support and promote inpatient stroke rehabilitation and recovery? and (c) What factors have been identified to impact nurses' working conditions on inpatient stroke rehabilitation units? A systematic search of multiple electronic databases retrieved seven studies which provided significant context and examples to these questions. What nurses do in practice included, for example, maximizing patients' independence in performing daily activities, preventing harm, and preserving integrity. How nurses perform their therapeutic roles included teaching, coaching, coordination, management, advocacy, collaboration. Factors that impact nurses' working conditions consisted of time, resources, and knowledge. This review demonstrates our current understanding of nurses' contributions to inpatient stroke rehabilitation, highlights their significant role, identifies current barriers/challenges of implementing stroke nursing care, and suggests ways of documenting and measuring nurses' contributions.

BALANCE, GAIT AND LATEROPULSION DISORDERS IN THE ACUTE ISCHEMIC STROKE

Introduction: Stroke mortality rates has decreased to a considerable value over the past few decades owing to the improved medical facilities and technology. This has lead to more number of stroke survivors in the aging population. A strong predictor of independent living after stroke is maintaining body balance and it was showing strong correlation with the disability perceived at the time of patient's discharge from the stroke rehabilitation unit Methodology: All patients with acute ischemic stroke were taken for study. These initial assessments collected information about handedness, all motor decits, postural instability and gait disorders, and disability affecting motor function. The second assessment was performed after one week of stroke at the discharge after daily physiotherapy and only focused on postural and gait disorders. Motor weakness was assessed by a standardized examination of muscle strength adapted for participants with central neurological disorders. Lateropulsion, gait and balance disorders were identied by specic protocols. Results: It was observed that the lesions of frontal lobe, thalamus, basal ganglia and internal capsule had signicant assosciation with balance and gait abnormality post stroke while lesions of parietal lobe, temporal lobe and occipital lobe did not lead to any signicant gait or balance decits. Individuals with lateropulsion improves well on daily physiotherapy in both Lw/oP (r = -0.65) and for pushers (r = -0.61) to a signicantly improved state( r= -0.5 for upright and r= -0.24 for pushers).Conclusion: Lateropulsion is a main factor in determining recovery of balance and gait in the subacute stage of stroke recovery. Special emphasis should be given to the impaired body orientation with respect to gravity in stroke rehabilitation stage and techniques to improve lateropulsion has to be stressed during physiotherapy for better recovery of balance and gait post stroke

Convergent Validity for the Functional Upper Extremity Levels (FUEL) in Stroke Rehabilitation.

Research is needed to validate an easy-to-use, functional, evidence-based neurological upper extremity (UE) assessment that requires minimal training. To establish convergent validity for the Functional Upper Extremity Levels (FUEL), a function-based upper limb measure, with the Upper Extremity Fugl-Meyer Assessment (UE-FMA), the gold standard assessment of upper limb recovery poststroke. Retrospective chart review of 292 clients with admission and discharge data for the UE-FMA and the FUEL. Correlation statistics were analyzed to determine a relationship between these assessments. Inpatient stroke rehabilitation unit. Clients with a stroke diagnosis admitted to the stroke inpatient rehabilitation unit at a rehabilitation hospital between January 2017 and June 2019. FUEL (a classification system) and UE-FMA (an impairment-based motor recovery assessment of the upper limb recovery poststroke). Pearson correlation coefficient yielded a significant positive correlation between the UE-FMA and the FUEL for both initial (r = .929) and discharge (r = .943) scores. Convergent validity of the FUEL is established using the UE-FMA as a comparison. The FUEL can be applied in neurological rehabilitation to provide a clinical picture of a client's UE function. This research supports the value of the FUEL's application in clinical poststroke care. What This Article Adds: The FUEL is a valid tool to assess the UE in an acute neurological population.

Informal Caregiver Stroke Program in Geriatric Rehabilitation of Stroke Patients: A Qualitative Study.

This study aimed to understand and gain insight into an informal caregiver program for caregivers of older stroke patients, which incorporates both skills training and education, in relation to caregiver burden. Semi-structured, in-depth interviews with individual informal caregivers were conducted at admission, at discharge, and six weeks after discharge. The program consisted of informal caregiver meetings, walk-in days, psychoeducation, and weekend leave after admission to a rehabilitation stroke unit in a nursing home. Eleven informal caregivers participated in the study. The informal caregiver meetings and walk-in days provided more insight into the (level of) functioning of the stroke patients, more skills in guiding them, and better communication with the multidisciplinary care team. During weekend leave, caregivers experienced what their roles as caregivers entailed. Six weeks after discharge, caregivers said that they did not miss any guidance during admission and that they were positive about the future. About half of the caregivers found the caregiver situation disappointing, and combining care tasks with daily tasks appeared to be difficult. Offering informal caregivers a tailor-made program during rehabilitation and good communication helps to diminish caregiver burden in the post-discharge phase when their relatives are back home.

Abstract WMP33: Cognitive Outcomes In Patients With A Prior History Of Stroke Participating In Inpatient Rehabilitation

Introduction: We sought to investigate the impact of prior stroke on cognitive improvement in stroke patients participating in inpatient rehabilitation. Methods: This was a retrospective review of clinical data from inpatient stroke rehabilitation (ISR) units collected from 09/2017- 08/2019. Age at onset, stroke type (ischemic or intracerebral hemorrhage (ICH)), therapy days, sex, and past medical history of stroke, diabetes, hypertension (HTN) were extracted as predictors of outcome in ISR. The baseline level of disability upon admission to acute stroke care was accounted for with pre-morbid modified Rankin scale (mRS) score and initial NIH Stroke Scale (NIHSS). The outcome variable of interest was total discharge cognitive functional independence measure (TDC-FIM) from ISR. FIM admission to ISR was controlled for in the model. Results: The data of 681 patients were used in a Lasso regression analysis (Figure 1), and of these patients there were 202 patients with a history of prior stroke. Univariate analysis showed a significant difference between prior stroke and first-time stroke groups with respect to pre-morbid mRS (p&lt;0.001), initial NIHSS (p = 0.003), HTN (p=0.004), and stroke type (p=0.023). Lasso regression indicated that patients with diabetes had a 0.58 point decrease in TDC-FIM while those with HTN had a 0.38 point decrease as compared to patients who did not have these vascular risk factors. Patients with ischemic stroke type had a 0.73 point decrease in the TDC-FIM as compared to those who had an ICH. Prior stroke and the patient’s sex had no effect on TDC-FIM. The R-squared of the model was 0.74. Conclusion: By controlling for vascular risk factors, our findings show no difference in TDC-FIM with respect to prior stroke. This is different from prior studies that found prior stroke was associated with worse cognitive outcomes at discharge from ISR. Our results indicate that managing HTN and diabetes is imperative for post-stroke cognitive rehabilitation

Development and field testing of a standardised goal setting package for person-centred discharge care planning in stroke

Develop and test a person-centred goal-setting package for discharge care planning in acute and rehabilitation stroke units. A multidisciplinary, expert working group (n = 15), and consumer group (n = 4) was convened. A multistage iterative approach was used to develop and test the package. Stages included: (i) contextual understanding, (ii) package development, and (iii) clinician training and field-testing in acute and rehabilitation settings. Observational field notes were taken and clinicians' perspectives captured using semi-structured focus groups post-testing. The final package included a 34-item menu aligned with a manual containing: guideline summaries; common goals; goal metrics based on the SMART Goal Evaluation Method (SMART-GEM); evidence-based strategies; and worked examples. Twenty-three clinicians attended training. Clinician observations (n = 5) indicated that: the package could be incorporated into practice; a range of person-centred goals were set; and opportunities provided to raise additional issues. Clinician feedback (n = 8) suggested the package was useful and facilitated person-centred goal-setting. Enablers included potential for incorporation into existing processes and beliefs that it promoted person-centred care. Barriers included additional time. The package demonstrated potential to facilitate comprehensive person-centred goal-setting for patients with stroke. We developed an innovative approach to support structured person-centred goal setting in clinical and research settings.

Stopping routine urine screening studies for stroke rehabilitation inpatient admissions

Urine testing on asymptomatic patients is not aligned with guidelines; however, stroke survivors have trouble communicating symptoms, and urinary tract infections (UTIs) are a recognised poststroke complication. All stroke inpatients...