Altering the rehabilitation environment to improve stroke survivor activity: A Phase II trial

Author:

Janssen Heidi123,Ada Louise4,Middleton Sandy56,Pollack Michael123,Nilsson Michael23,Churilov Leonid6,Blennerhassett Jannette7,Faux Steven8,New Peter910,McCluskey Annie4,Spratt Neil J123,Bernhardt Julie11,

Affiliation:

1. Hunter New England Local Health District, Australia

2. Hunter Medical Research Institute, Australia

3. College of Health, Medicine and Wellbeing, University of Newcastle, Australia

4. Faculty of Medicine and Health, University of Sydney, Australia

5. Faculty of Health Sciences Department, Nursing Research Institute, Australia

6. Department of Medicine, University of Melbourne, Australia

7. Health Independence Program and Physiotherapy Department, Austin Health, Australia

8. Departments of Rehabilitation Medicine and Pain Medicine, St Vincent’s Hospital, Australia

9. Department of Medicine & Rehabilitation and Aged Services Program, Monash Health, Australia

10. Monash Medical School & Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Australia

11. The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia

Abstract

Background Environmental enrichment involves organization of the environment and provision of equipment to facilitate engagement in physical, cognitive, and social activities. In animals with stroke, it promotes brain plasticity and recovery. Aims To assess the feasibility and safety of a patient-driven model of environmental enrichment incorporating access to communal and individual environmental enrichment. Methods A nonrandomized cluster trial with blinded measurement involving people with stroke ( n = 193) in four rehabilitation units was carried out. Feasibility was operationalized as activity 10 days after admission to rehabilitation and availability of environmental enrichment. Safety was measured as falls and serious adverse events. Benefit was measured as clinical outcomes at three months, by an assessor blinded to group. Results The experimental group ( n = 91) spent 7% (95% CI −14 to 0) less time inactive, 9% (95% CI 0–19) more time physically, and 6% (95% CI 2–10) more time socially active than the control group ( n = 102). Communal environmental enrichment was available 100% of the time, but individual environmental enrichment was rarely within reach (24%) or sight (39%). There were no between-group differences in serious adverse events or falls at discharge or three months or in clinical outcomes at three months. Conclusions This patient-driven model of environmental enrichment was feasible and safe. However, the very modest increase in activity by people with stroke, and the lack of benefit in clinical outcomes three months after stroke do not provide justification for an efficacy trial.

Funder

Greater Charitable Foundation Fellows in Stroke Research

Australian NHMRC/NHF Career Development/Future Leader Fellowship

New South Wales Cardiovascular Research Network Project Grant 2014

NIH/NCRR Colorado CTSI

Kiriwina Investments through Hunter Medical Research Institute

Publisher

SAGE Publications

Subject

Neurology

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