Addressing inactivity after stroke: The Collaborative Rehabilitation in Acute Stroke (CREATE) study.

Area of Science:

• Healthcare Improvement Science
• Patient Experience Research
• Rehabilitation Medicine

Background:

• Stroke patients often exhibit inactivity post-discharge, a persistent challenge in rehabilitation.
• Existing interventions and organizational changes have not fully resolved this issue.
• Experienced-based co-design (EBCD) is an improvement methodology explored to address this gap.

Purpose of the Study:

• To assess the feasibility and impact of EBCD in increasing patient activity in stroke units.
• To evaluate patient, carer, and staff co-design and implementation of improvements.
• To compare the effectiveness of full versus accelerated EBCD cycles.

Main Methods:

• A mixed-methods case comparison study was conducted in four English stroke units.
• Data collection included interviews (n=156), ethnographic observations (364 hours), behavioral mapping (n=68), and patient surveys (n=179).
• Improvements were co-designed and implemented focusing on space, activity opportunities, and communication.

Main Results:

• Over 40 improvements were implemented, enhancing stroke unit environments and activity opportunities.
• Post-implementation data indicated increased use of social spaces and activity options.
• Despite environmental changes, staff interactions remained task-focused, and recorded activity level changes were variable and inconclusive.

Conclusions:

• EBCD is a feasible methodology for improving stroke unit environments and activity provisions.
• The study found minimal impact on actual patient activity levels.
• No significant difference was observed between full and accelerated EBCD cycles, suggesting broader applicability in stroke care settings.