Are the effects of an enriched environment on patient activity sustained over time in an acute stroke unit?

Abstract

Background: Sustainability of an enriched environment beyond a clinical trial has not yet been investigated. This study determined if increased activity levels were sustained six-months post implementation of an enriched environment. Methods: Follow-up post a controlled before-after pilot study. Stroke patients in an acute stroke unit were recruited to a sustainability group three months following completion of an enriched environment intervention study. The enrichment model incorporated stimulating resources, communal areas for eating and socializing, and daily group activities. Change management strategies were used to support staff to deliver the intervention on the ward. At intervention completion, all change management strategies were withdrawn, while the enrichment model was maintained. Behavioural mapping was used to estimate patient activity levels, body position, location and people present. Participants were observed every 10-minutes between 7.30am and 7.30 pm within the first 10-days after stroke. Results: The sustainability group (n=30, mean age 73.8±17.4) showed no difference in proportion of time spent in 'any' (p=0.120), physical (p=0.114), social (p=0.56) and cognitive (p=0.124) activity compared to the enriched environment group (n=30, mean age 76.7±12.1). A significant difference was found for the sustainability participants, who were more in 'supine position' (p<0.001) or their room (p=0.001) than the enriched group. Time spent 'being alone' was unchanged (p=0.120). Conclusion: The effect of an enriched environment on patient activity levels was sustained six-months post implementation. However, patients returned to being in bed in their room. Prolonged use of change management strategies that support staff to maintain new work routines may be critical.L618235968 <br />