Independent Arm and Hand Exercise After Stroke
Research type
Research Study
Full title
The Development of a Toolkit to Support Self-directed Upper Limb Exercise after Stroke
IRAS ID
315630
Contact name
Madeleine Kenny
Contact email
Sponsor organisation
Leeds Teaching Hospitals NHS Trust
Duration of Study in the UK
1 years, 9 months, 1 days
Research summary
Summary of Research
About 60% of people who have a stroke have a weak, un-coordinated arm. There is good evidence that it takes hundreds of repetitions of exercises to help arm recovery. Some of this practice can be done with the therapists. However, to achieve the amount needed, lots of practice needs to be done independently. This research aims to help people with stroke practise enough of the needed exercises to get the best recovery from their arm. It is focussed on the first part of recovery after stroke, whilst still in hospital.
An earlier phase of this research looked at the evidence already available to work out what helped, and what hindered therapists giving out exercises for the arm and hand in hospital. It also looked at who benefitted most from being given the exercises and why, and who found them hard to do, and why. This is important, as we are all different, and what works for one person may not work for another.
This part of the study develops this knowledge further, by looking at what happens in real life. The researcher will watch what happens on a busy stroke ward and then talk to the therapists and patients to understand what makes giving out or doing arm and hand exercises work or not.
This information will then be all pulled together to create a toolkit to make it easier for therapists to prescribe exercises that suit the individuals they are giving them to, tailored to their differing needs. The toolkit will be co-designed by people who have had a stroke, and therapists together.
Finally, the toolkit will be tested on the stroke units used earlier in the study, so that patients and therapists can help to resolve any problems that come to light when using it in real life.Summary of Results
After a stroke, many people experience weakness or difficulty using their arm and hand. Regular, repeated exercise is important for recovery, but in UK hospitals people often do not receive as much arm exercise as recommended. One way to help address this gap is through self-directed exercises – exercises that stroke survivors can do on their own, outside of formal therapy sessions. In practice, however, these exercises are not always prescribed or carried out.This study aimed to understand how and why therapists decide to prescribe self-directed arm exercises after stroke, and what helps or makes it harder for stroke survivors to do these exercises. Rather than testing a single intervention, the study focused on understanding how self-directed exercise works in real-world rehabilitation settings.
A realist research approach was used, which explores what works, for whom, and under what circumstances. First, existing research was reviewed to develop an initial explanation of how self-directed exercises are prescribed and used. This explanation was then refined using observations and interviews with therapists and stroke survivors.
The findings showed that therapists were more likely to prescribe self-directed exercises when they felt a person was ready and motivated to take part. Therapists often work under time pressure and tended to prioritise people who showed signs of confidence, interest, or an ability to take responsibility for their exercises. Feeling accountable and believing that the exercises would lead to meaningful improvement appeared to influence both therapists’ decisions and stroke survivors’ engagement.
Based on these findings, two practical tools were co-developed with therapists and stroke survivors. The first was a conversation guide to support shared discussions about planning arm exercises, helping stroke survivors feel prepared to exercise and to explain what works best for them. The second was a quality improvement framework to help therapists reflect on and improve how they prescribe self-directed exercises.
Overall, this study improves understanding of how self-directed arm exercises are prescribed and used after stroke and provides a strong foundation for developing future interventions to improve rehabilitation and recovery outcomes
REC name
West of Scotland REC 5
REC reference
23/WS/0080
Date of REC Opinion
13 Jun 2023
REC opinion
Further Information Favourable Opinion