Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: Results of a pilot study

Abstract

Background and Rationale: An enriched environment (EE) significantly improves functional recovery in animal models of stroke and can increase activity levels in people with stroke in subacute inpatient rehabilitation. We sought to translate an EE into an Acute Stroke Unit (ASU) and determine if our model of enrichment could increase activity levels (primary outcome) and safety (secondary outcome) after stroke. Methods: A before-after pilot study utilising behavioural mapping every 10 minutes between 7.30 am and 7.30 pm was conducted to compare activity levels of stroke patients recovering in an enriched and non-enriched ASU. Patients were observed within 10 days post stroke. The EE was comprised of: communal areas for eating and socialising, group activities and provision of equipment including newspapers, magazines, books, music and IPads. Staff focus towards enabling patient activity was reinforced through interdisciplinary education and appointing nurse champions. Differences between group activity levels were determined using one-way ANCOVA adjusting for age, stroke severity and premorbid function. Results: Sixty stroke patients participated, 30 exposed to an enriched (mean age 76.7; SD 12.1) and 30 to a non-enriched (mean age 76.0; SD 12.8) ASU. Patients in the enriched ASU spent a higher proportion of their day engaged in activity compared to patients in a non-enriched ASU (71% vs. 58%, p = 0.005). They were more engaged in physical (33% vs. 22%, p < 0.001), social (40% vs. 29%, p = 0.007) and cognitive (59% vs. 45%, p = 0.002) activity and spent less of their day in a supine position (45% vs. 68%, p < 0.001). Fewer patients in the enriched ASU experienced adverse events (n = 7 vs. n = 16) and serious adverse events (n = 4 vs. n = 11). Conclusion: Use of our model of EE in an ASU increased activity levels in people with stroke. A Phase II trial is needed to determine the feasibility and safety of our model as an important preliminary step to determining functional efficacy in a Phase III Trial.<br />