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

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.

Keywords

Stroke clinical trial rehabilitation environmental enrichment activity recovery

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References

Krakauer

Carmichael

Corbett

, et al.

Getting neurorehabilitation right: what can be learned from animal models?

Neurorehabil Neural Repair 2012; 26: 923–931.

Stroke Foundation. National stroke audit - acute services report, Melbourne, Australia: Stroke Foundation, 2019.

Stroke Foundation. National stroke audit – rehabilitation services report, Melbourne, Australia: Stroke Foundation, 2018.

Burris

. Stroke rehabilitation: current American Stroke Association guidelines, care, and implications for practice. Missouri Med 2017; 114: 40–43.

Stroke Foundation. Clinical guidelines for stroke management, https://informme.org.au/en/Guidelines/Clinical-Guidelines-for-Stroke-Management. (2020, accessed 22 May 2020).

West

Bernhardt

. Physical activity in hospitalised stroke patients. Stroke Res Treatment 2012; 2012: 813765.

Janssen

Ada

Bernhardt

, et al. Physical, cognitive and social activity levels of stroke patients undergoing rehabilitation within a mixed rehabilitation unit. Clin Rehabil 2014; 28: 91–101.

Putman

De Wit

. European comparison of stroke rehabilitation. Topics Stroke Rehabil 2009; 16: 20–26.

Mattlage

Redlin

Rippee

, et al. Use of accelerometers to examine sedentary time on an acute stroke unit. J Neurol Phys Ther 2015; 39: 166–171.

10.

Poulos

. Evaluating inpatient public rehabilitation in Australia using a utilization review tool developed in North America. J Rehabil Med 2010; 42: 246–253.

11.

Mackey

Ada

Heard

, et al.

Stroke rehabilitation: are highly structured units more conducive to physical activity than less structured units?

Arch Phys Med Rehabil 1996; 77: 1066–1070.

12.

Janssen

Bernhardt

Collier

, et al. An enriched environment improves sensorimotor function post-ischemic stroke. Neurorehabil Neural Repair 2010; 24: 802–813.

13.

Nithianantharajah

Hannan

. Enriched environments, experience-dependent plasticity and disorders of the nervous system. Nat Rev Neurosci 2006; 7: 697–709.

14.

Jeffers

Corbett

. Synergistic effects of enriched environment and task-specific reach training on poststroke recovery of motor function. Stroke 2018; 49: 1496–1503.

15.

Janssen

Ada

Karayanidis

, et al. Translating the use of an enriched environment poststroke from bench to bedside: study design and protocol used to test the feasibility of environmental enrichment on stroke patients in rehabilitation. Int J Stroke 2012; 7: 521–526.

16.

Janssen

Ada

Bernhardt

, et al. An enriched environment increases activity in stroke patients undergoing rehabilitation in a mixed rehabilitation unit: a pilot non-randomized controlled trial. Disabil Rehabil 2014; 36: 255–262.

17.

Khan

Amatya

Elmalik

, et al. An enriched environmental programme during inpatient neuro-rehabilitation: A randomized controlled trial. J Rehabil Med 2016; 48: 417–425.

18.

Grol

Grimshaw

. From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003; 362: 1225–1230.

19.

Lang

Wyer

Haynes

. Knowledge translation: closing the evidence-to-practice gap. Ann Emerg Med 2007; 49: 355–363.

20.

Bayley

Hurdowar

Richards

, et al. Barriers to implementation of stroke rehabilitation evidence: findings from a multi-site pilot project. Disabil Rehabil 2012; 34: 1633–1638.

21.

Middleton

Lydtin

Comerford

, et al. From QASC to QASCIP: successful Australian translational scale-up and spread of a proven intervention in acute stroke using a prospective pre-test/post-test study design. BMJ Open 2016; 6: e011568.

22.

King

McCluskey

Schurr

. The time use and activity levels of inpatients in a co-located acute and rehabilitation stroke unit: an observational study. Topics Stroke Rehabil 2011; 18: 654–665.

23.

Luker

Lynch

Bernhardsson

, et al. Stroke survivors' experiences of physical rehabilitation: a systematic review of qualitative studies. Arch Phys Med Rehabil 2015; 96: 1698–1708.

24.

Ada

Dean

Mackey

. Increasing the amount of physical activity undertaken after stroke. Phys Ther Rev 2006; 11: 91–100.

25.

Clarke

Burton

Tyson

, et al. Why do stroke survivors not receive recommended amounts of active therapy? Findings from the ReAcT study, a mixed-methods case-study evaluation in eight stroke units. Clin Rehabil 2018; 32: 1119–1132.

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