Trial has potential to change lives of stroke patients
25 January 2010
In the next ten years it's predicted that more than half a million people will have a stroke and about 88 per cent of survivors will be living at home with a disability. A new trial being undertaken at the University of Sydney has the potential to improve the quality of life and independence of these stroke survivors through changing the mode of community rehabilitation.
The University's Faculty of Health Sciences is leading the Out-and-About Trial which aims to change the practice of rehabilitation teams working with stroke patients in the community, to encourage more outdoor journeys, travel over greater distances and even the possibility of resuming driving.
Best practice guidelines recommend access to walking training conducted by a physiotherapist and travel training with an occupational therapist. Yet fewer than 20 per cent of stroke patients currently receive enough escorted sessions within their local community to gain confidence and improve outcomes.
"The majority receive intervention at outpatient departments in clinics or hospitals and therapists struggle with translating these guidelines into practice," says Chief Investigator, Dr Annie McCluskey. "Therapists endeavour to get out and about with stroke survivors in their own streets and suburbs. However, it is difficult for them to block out two hours or more per session to escort people; across busy three lane highways, over rough ground and on and off public transport."
"Maybe it's partly to do with not having done this before…," reports an Occupational Therapist "gosh…how do I get people on buses? And time wise…how do I manage?"
However McCluskey argues that escorted training in the community is what can make all the difference to a person's confidence.
Building on an earlier pilot study funded by the National Stroke Foundation, the trial is being conducted with a $566 600 Project Grant from the National Health and Medical Research Council. Twenty community teams and 300 stroke survivors will be involved.
"This is about education and changing therapists' behaviour," explains Associate Professor Louise Ada, an expert in neurological physiotherapy and investigator on the project.
"While many practitioners may be aware of the research behind this, they don't know how or don't have the time to implement it with clients. The purpose of this project is to give them the knowledge, training and feedback to be able achieve this."
The trial will compare different types of education and coaching delivered to rehabilitation teams in the community. The key measure will be the proportion of stroke survivors being taken on multiple outdoor journeys by physiotherapists and occupational therapists.
The project will also use personal global positioning systems (GPS) to assess how far and how often people go out.
"The use of the GPS is quite revolutionary in this context as previous tools like pedometers didn't allow us to measure journeys and distance when riding in cars or on buses. Furthermore the combination of GPS with google maps technology allows us to map the journeys taken by people with stroke during a day, and visits to venues like libraries or local shops. This can tell us a lot about quality of life and independence," comments McCluskey.
If proven cost-effective and transferable, the Out-and-About program has the potential to be rolled out across Australia, making it available to hundreds of community rehabilitation teams. With stroke costing Australia an estimated $2.14 billion a year, the flow on effects of less reliance on medical and care services are anticipated to be significant.
Ultimately the end winners will be the stroke survivors themselves who will regain confidence in their own ability and become a member of the community again.
As one patient from the pilot recounts, "Walking…that's the biggest thing, I suppose if I could get back to some sort of normality with that… I'd just like to be back to where I was before."
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