Investigation of the implementation of a Communication Enhanced Environment model on an acute/slow stream rehabilitation and a rehabilitation ward: A before-and-after pilot study
Restricted accessResearch articleFirst published online January, 2022
Investigation of the implementation of a Communication Enhanced Environment model on an acute/slow stream rehabilitation and a rehabilitation ward: A before-and-after pilot study
Develop and implement a Communication Enhanced Environment model and explore its effect on language activities for patients early after stroke.
Method and design:
Before-and-after pilot study.
Setting:
An acute/slow stream rehabilitation and a rehabilitation ward in a private hospital in Perth, Western Australia.
Participants:
Fourteen patients recruited within 21 days of stroke. Seven recruited during the before-phase (control group: patients with aphasia = 3, patients without aphasia = 4) and seven recruited in the after-phase (intervention group: patients with aphasia = 4, patients without aphasia = 3).
Intervention:
The intervention group exposed to a Communication Enhanced Environment model had access to equipment, resources, planned social activities and trained communication partners. Both groups received usual stroke care.
Data collection:
Hospital site champions monitored the availability of the intervention. Behavioural mapping completed during the first minute of each 5-minute interval over 12 hours (between 7 am and 7 pm) determined patient engagement in language activities.
Results:
Seventy-one percent of the Communication Enhanced Environment model was available to the intervention group who engaged in higher, but not significant (95% CI), levels of language activities (600 of 816 observation time points, 73%) than the control group (551 of 835 observation time points, 66%). Unforeseen reorganisation of the acute ward occurred during the study.
Conclusions:
Implementation of a Communication Enhanced Environment model was feasible in this specific setting and may potentially influence patients’ engagement in language activities. The unforeseen contextual challenges that occurred during the study period demonstrate the challenging nature of the hospital environment and will be useful in future research planning.
EngelterATGostynskiMPapaS, et al. Epidemiology of aphasia attributable to first ischemic stroke. Stroke2006; 37: 1379–1384.
2.
PedersonPMJørgensenHSNakayamaH, et al. Aphasia in acute stroke: incidence, determinants, and recovery. Ann Neurol1995; 38(4): 659–666.
3.
KruithofWJvan MierloMLVisser-MeilyJM, et al. Associations between social support and stroke survivors’ health-related quality of life – a systematic review. Patient Educ Couns2013; 93(2): 169–76.
4.
GodeckeEArmstrongEHershD, et al. Missed opportunities: communicative interactions in early stroke recovery. In: Int J Stroke: Proceedings of the Stroke Society of Australasia Annual Scientific Meeting. 2014 July 30-Aug 1; Hamilton Island, Queensland. Worlds Stroke Organization; 2014. p 48.
5.
MurphyTHCorbettD. Plasticity during stroke recovery: from synapse to behaviour. Nat Neurosci2009; 10: 861–872.
6.
EngXBrauerSGKuysSS, et al. Factors affecting the ability of the stroke survivor to drive their own recovery outside of therapy during inpatient stroke rehabilitation. Stroke Res Treat2014; 2014: 626538.
7.
KarelinaKNormanGJZhangN, et al. Social contact influences histological and behavioral outcomes following cerebral ischemia. Exp Neurol2009; 220: 276–282.
8.
NithianantharajahJHannanAJ. Enriched environments, experience dependent plasticity and disorders of the nervous system. Nat Rev Neurosci2006; 7(9): 697–709.
9.
JanssenHBernhardtJCollierJM, et al. An enriched environment improves sensorimotor function post–ischemic stroke. Neurorehabil Neural Repair2010; 24(9): 802–813.
10.
JanssenHAdaLBernhardtJ, et al. An enriched environment increases activity in stroke patients undergoing rehabilitation in a mixed rehabilitation unit: a pilot non-randomized controlled trial. Disabil Rehabil2014; 36(3): 255–262.
11.
RosbergenICMGrimleyRSHaywardKS, et al. Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: a controlled before–after pilot study. Clin Rehabil2017; 31(11): 1516–1528.
12.
JanssenHAdaLMiddletonS, et al. Altering the rehabilitation environment to improve stroke survivor activity: a phase II trial. Int J Stroke. Epub ahead of print 13 April 2021. DOI: 10.1177/17474930211006999.
13.
D’SouzaSGodeckeECicconeN, et al. Hospital staff, volunteers’, and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study. BMJ Open2021; 11(5): e043897.
14.
TeasdaleGJennettB. Assessment of coma and impaired consciousness. A practical scale. Lancet1974; 2(7872): 81–84.
15.
D’SouzaSHershDGodeckeE, et al. Patients’ experiences of a Communication Enhanced Environment model in an acute and rehabilitation ward following stroke: a qualitative description approach. Disabil Rehabil (under review).
16.
D’SouzaSCicconeNHershD, et al. Staff and volunteer perceptions of a Communication Enhanced Environment model in an acute and a rehabilitation hospital ward: a qualitative description study within a before-and after pilot study. Disabil Rehabil (under review).
NasreddineZSPhillipsNABédirianV, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc2005; 53(4): 695–699.
19.
KerteszA. Western Aphasia battery. Revised. San Antonio, TX: Harcourt Assess.
20.
CoulsonNSFergusonMAHenshawH, et al. Applying theories of health behaviour and change to hearing health research: time for a new approach. Int J Audiol2016; 55(Suppl 3): S99–S104.
21.
BurnettSBennJPintoA, et al. Organisational readiness: exploring the preconditions for success in organisation-wide patient safety improvement programmes. Qual Saf Health Care2010; 19(4): 313–317.
22.
GrahamIDLoganJHarrisonMB, et al. Lost in knowledge translation: time for a map?J Contin Educ Health Prof2006; 26: 13–24.
23.
MichieSvan StralenMMWestR. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci2011; 6(42): 1–11.
24.
MichieSWoodCEJohnstonM, et al. Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behavior change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data). Health Technol Assess2015; 19(99): 1–188.
25.
BradyMCKellyHGodwinJ, et al. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev2016; 1(6): CD000425.
26.
KaganA. Supported conversation for adults with aphasia: methods and resources for training conversation partners. Aphasiology1998; 12(9): 816–830.
27.
The AVERT Trial Collaboration Group. Efficacy and safety of very early mobilisation within 24h of stroke onset (AVERT): a randomised controlled trial. Lancet2015; 386: 46–55.
28.
GodeckeEArmstrongERaiT, et al. A randomized control trial of intensive aphasia therapy after acute stroke: the Very Early Rehabilitation for SpEech (VERSE) study. Int J Stroke. Epub ahead of print 6 October 2020. DOI: 10.1177/1747493020961926.
BallJEMurrellsTRaffertyAM, et al. ‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care. BMJ Qual Saf2014; 23(2): 116–125.
31.
ShannonMMLipson-SmithRElfM, et al. Bringing the single versus multi-patient room debate to vulnerable patient populations: a systematic review of the impact of room types on hospitalized older people and people with neurological disorders. Intell Build Int2020; 12(30): 180–198.
32.
PloegJDaviesBEdwardsN, et al. Factors influencing best-practice guideline implementation: lessons learned from administrators, nursing staff, and project leaders. Worldviews Evid Based Nurs2007; 4(4): 210–219.
33.
RosbergenICMBrauerSGFitzhenryS, et al. Qualitative investigation if the perceptions and experiences of nursing and Allied Health professionals involved in the implementation of an enriched environment in and Australian acute stroke unit. BMJ Open2017; 7(12): e018226.
34.
WhiteJHBartleyEJanssenH, et al. Exploring stroke survivor experience of participation in an enriched environment: a qualitative study. Disabil Rehabil2015; 37(7): 593–600.
35.
BauerMSKirchnerJ. Implementation science: what is it and why should i care?Psychiatry Res2020; 283; 112376.
36.
LynchEAChesworthBMConnellLA. Implementation – the missing link in the research translation pipeline: is it any wonder no one ever implements evidence-based practice?Neurorehabil Neural Repair2018; 32(9): 751–761.
37.
BartlettGBlaisRTamblynR, et al. Impact of patient communication problems on the risk of preventable adverse events in acute care settings. Can Med Assoc J2008; 178(12): 1555–1562.
38.
LeggCYoungLBryerA. Training sixth-year medical students in obtaining case-history information from adults with aphasia. Aphasiology2005; 19(6): 559–575.
39.
StreetRLMakoulGAroraNK, et al. How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Couns2009; 74: 295–301.
40.
DuncanEO’CathainARousseauN, et al. Guidance for reporting intervention development studies in health research (GUIDED): an evidence-based consensus study. BMJ Open2020; 10(4): e033516.
41.
EldridgeSMChanCLCampbellMJ, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ2016; 355: i5239.
42.
HoffmannTGlasziouPBoutronI, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ2014; 348: g1687.
