Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: A controlled before–after pilot study

Abstract

Objectives: To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute stroke patients and reduce adverse events. Design: Controlled before–after pilot study. Setting: An acute stroke unit in a regional Australian hospital. Participants: Acute stroke patients admitted during (a) initial usual care control period, (b) an enriched environment period and (c) a sustainability period. Intervention: Usual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing and daily group activities. Change management strategies were used to implement an enriched environment within existing staffing levels. Main Measures: Behavioural mapping was used to estimate patient activity levels across groups. Participants were observed every 10 minutes between 7.30 am and 7.30 pm within the first 10 days after stroke. Adverse and serious adverse events were recorded using a clinical registry. Results: The enriched environment group (n = 30, mean age 76.7 ± 12.1) spent a significantly higher proportion of their day engaged in ‘any’ activity (71% vs. 58%, P = 0.005) compared to the usual care group (n = 30, mean age 76.0 ± 12.8). They were more active in physical (33% vs. 22%, P < 0.001), social (40% vs. 29%, P = 0.007) and cognitive domains (59% vs. 45%, P = 0.002) and changes were sustained six months post implementation. The enriched group experienced significantly fewer adverse events (0.4 ± 0.7 vs.1.3 ± 1.6, P = 0.001), with no differences found in serious adverse events (0.5 ± 1.6 vs.1.0 ± 2.0, P = 0.309). Conclusions: Embedding an enriched environment in an acute stroke unit increased activity in stroke patients. (PsycINFO Database Record (c) 2017 APA, all rights reserved)Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia. Other Publishers: Hodder Arnold. Release Date: 20171221. Publication Type: Journal (0100), Peer Reviewed Journal (0110). Format Covered: Electronic. Document Type: Journal Article. Language: English. Grant Information: Rosbergen, Ingrid C.M. Major Descriptor: Cerebrovascular Accidents; Health Care Delivery; Intervention; Nursing. Minor Descriptor: Disease Management; Socialization. Classification: Health & Mental Health Services (3370). Population: Human (10); Male (30); Female (40). Location: Australia. Age Group: Adulthood (18 yrs & older) (300). Tests & Measures: Mobility Scale for Acute Stroke; Modified Barthel Index; EuroQol 5 Dimensions 3 Level Version; National Institutes of Health Stroke Scale DOI: 10.1037/t35126-000; Hospital Anxiety and Depression Scale DOI: 10.1037/t03589-000; Visual Analogue Scale. Methodology: Clinical Trial; Empirical Study; Longitudinal Study; Prospective Study. Page Count: 13. Issue Publication Date: Nov, 2017. Publication History: Accepted Date: Mar 26, 2017; First Submitted Date: Sep 24, 2016. Copyright Statement: The Author(s). 2017.Sponsor: Wishlist Foundation. Recipients: No recipient indicated <br />Sponsor: Sunshine Coast Hospital and Health Service (SCHHS), Australia. Other Details: Research grant; Scholarship (I.R.). Recipients: Rosbergen, Ingrid C.M. <br />Sponsor: Queensland Health, Australia. Other Details: Health Practitioner research grant. Recipients: No recipient indicated <br />Sponsor: Acute Stroke Unit. Recipients: Rosbergen, Ingrid C.M. <br />Sponsor: SCHHS, Allied Health Services, Australia. Recipients: Rosbergen, Ingrid C.M. <br />Sponsor: National Health and Medical Research Council, Australia. Grant: 1088449. Recipients: Hayward, Kathryn S. <br />Sponsor: Michael Smith Foundation for Health Research, Canada. Recipients: Hayward, Kathryn S. <br />Sponsor: Heart and Stroke Foundation of Canada, Canada. Recipients: Hayward, Kathryn S. <br />