Winning hearts and minds: How can post-stroke activity be increased to implement the national clinical guidelines?

Abstract

Introduction: Post-stroke inactivity is associated with physical, neuropsychological, and psychosocial complications. Clinical guidelines recommend people be supported to remain active for up to 6-hours per day. This GIRFT Stroke Leadership Academy Quality Improvement Project (QIP) sought to understand current practice, including challenges/opportunities, to inform new ways of working.

Method: Utilising Kaizen principles, the project took place across three hospital trusts, including HASU(H), ASU(A) and Rehabilitation(R) settings, in England. QIP activities included: Cross-sectional survey of patients views/preferences (A); Behavioural mapping observations of physical, social and cognitive activity (15-min intervals; 7am-7pm; 7-days) (H,A,R); and MDT focus groups to ascertain perceptions and attitudes regarding activity provision (A). Quantitative data were analysed using descriptive statistics, qualitative with thematic analysis.

Results or details of the case: Of 19 surveyed patients, 68% (N=13) did not feel they undertook enough activity outside therapy. Preferred increased provision included: balance; strengthening; stroke education; and self-care. Behaviour mapping (N=75 patients) resulted in 25,200 observation time points. Time spent in activity differed across settings, averaging at 5.6 hours. The MDT felt increased education, training, resources and a collaborative long-term approach were required to effectively implement guidelines. Staff beliefs and fear of doing harm were significant barriers, nevertheless a variety of interventions were suggested for future implementation and evaluation.

Conclusion: Patients and staff support an increase in post-stroke activity provision. Work is required to overcome existing beliefs and effect culture change. The project findings will inform further implementation and evaluation activities, with a view to influencing wider spread, adoption and scale-up, to meet the recommended 6-hours.