ULRAS Study: Upper Limb Rehabilitation After Stroke

• Research type

  Research Study

• Full title

  An ethnographic study of stroke rehabilitation services in England for the purpose of identifying targets for service improvement

• IRAS ID

  231477

• Contact name

  Nicholas Appelbaum

• Contact email

  nick@helixcentre.com

• Sponsor organisation

  Imperial College London

• Duration of Study in the UK

  1 years, 0 months, 0 days

• Research summary

  Research Summary

  Stroke is the leading cause of disability in the UK, and arm weakness affects more than three quarters of all stroke survivors. Early and continued access to therapy is critical for recovery, especially during the first three months. Unfortunately, after leaving hospital the amount of rehabilitation received is often greatly reduced.

  This research seeks to develop a greater understanding of arm rehabilitation after stroke and gain the patients’, therapists’ and organisation managers’ opinions and experiences. To do this we will complete interviews and observations with patients, therapists and managers. The information we gain from this research will help us to develop an intervention to improve arm rehabilitation after stroke.

  Summary of Results

  ULRAS: Upper-limb rehabilitation after stroke Summary

  Background
  The Helix Centre at Imperial College London is leading a project to improve rehabilitation after stroke. The project has recently concluded a scoping exercise aiming to increase the understanding of the neurorehabilitation needs of users and providers in both acute and community settings. Through this process we have identified new opportunities for improving rehabilitation services for stroke.
  The team established key collaboration agreements with three NHS Trusts, in both acute and community settings:
  1. Imperial College NHS Trust (acute)
  2. Hounslow and Richmond Community Healthcare NHS Trust (community) 3. Central London Community Healthcare NHS Trust (community)

  In addition we have been collaborating closely with charity groups and patient support networks:
  Stroke Association
  Different Strokes
  London Exercise Group for Stroke

  Work to date
  The team worked with NHS trusts, stroke charities and private hospitals to identify specific gaps in the current delivery of stroke rehabilitation. 23 participants (including patients and carers) have provided their views. Staff members from acute and community settings have also contributed their knowledge and experience. During this time we spoke to individuals, ran workshops, attended multidisciplinary meetings and observed treatment sessions. Through these interactions it became clear that there are two components to a patients rehabilitation. The first component is during their allocated treatment time in-therapy, lasting about. 45 minutes, either with a therapist or alone. The second component is the rest of the day, the ‘out of therapy time’ (OOT). Research has shown that the in-therapy time is often not maximised as patients struggle to motivate themselves to do their exercises and/or are not sure on exactly what exercises to do. The second component of rehabilitation, the OOT, makes up the majority of a person's day and is currently being underutilised. The tasks a person does every day during their OOT, such as getting washed and dressed, can actually be used as part of their rehabilitation program.
  By working closely with patients and therapists we have developed an initial proof of concept (POC) of a rehabilitation platform that allows patients to keep track of their improvement during exercises and to optimise the activities they do throughout the day. Our proposal envisages patients wearing an activity tracker during exercise sessions and throughout the rest of the day patients to collect data on movement of their impaired arm. This data can then be fed back to patients, and their therapists at opportune moments to encourage more movement, highlight progress and give an insight into inactive times. In addition to this, the platform could offer patients tips on how to involve their arm more in everyday life, as well as daily reminders do their exercises and remain focused on their goals.

  Next steps
  Our focus for the next phase of development will be on the Out of Therapy service described above, as we continue to develop this service and address the opportunity, we will use this data and increased understanding to innovate solutions for focused rehabilitation and exercises with professionals.
  We have identified a couple of grant opportunities that could help us in the development of the intervention as well as support a feasibility trial as a next milestone. Secondly, the aim for the project is to demonstrate improved outcomes through clinical trials with the ultimate aim to implement the service in clinical practice.

• REC name

  London - Queen Square Research Ethics Committee

• REC reference

  17/LO/1805

• Date of REC Opinion

  14 Nov 2017

• REC opinion

  Further Information Favourable Opinion