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Addressing inactivity after stroke: The Collaborative Rehabilitation in Acute Stroke (CREATE) study.

Research output: Contribution to journalArticle

Fiona Jones, Karolina Gombert-Waldron, Stephanie Honey, Geoffrey C Cloud, Ruth Harris, Alastair Macdonald, Christopher McKevitt, Glenn Robert, David Clarke

Original languageEnglish
Number of pages24
JournalInternational Journal Of Stroke
Accepted/In press4 Sep 2020


  • IJS 240820 (002)

    IJS_240820_002_.docx, 127 KB, application/vnd.openxmlformats-officedocument.wordprocessingml.document

    Uploaded date:04 Sep 2020

    Version:Accepted author manuscript

King's Authors


Background: Stroke patients are often inactive outside of structured therapy sessions – an enduring international challenge despite large scale organisational changes, national guidelines and performance targets. We examined whether Experienced-based Co-design (EBCD) - an improvement methodology- could address inactivity in stroke units.

Aims: To evaluate the feasibility and impact of patients, carers and staff co-designing and implementing improvements to increase supervised and independent therapeutic patient activity in stroke units and to compare use of full and accelerated EBCD cycles.

Methods: Mixed-methods case comparison in four stroke units in England.

Results: Interviews n=156 patients, staff and carers, ethnographic observations –n=365 hours, behavioural mapping n=68 patients, and self-report surveys n=182 patients pre and post implementation of EBCD improvement cycles.
Three priority areas emerged 1) ‘Space’ (environment) 2) ‘Activity opportunities’ and 3) ‘Communication’. More than 40 improvements were co-designed and implemented to address these priorities across participating units. Post-implementation interview and ethnographic observational data confirmed use of new social spaces and increased activity opportunities. However, staff interactions remained largely task-driven with limited focus on enabling patient activity. Behavioural mapping indicated some increases in social, cognitive and physical activity post-implementation but was variable across sites. Survey responses rates were low at 12-38% and inconclusive.

Conclusion It was feasible to implement EBCD in stroke units. This resulted in multiple improvements in stroke unit environments and increased activity opportunities but minimal change in recorded activity levels. There was no discernible difference in experience or outcome between full and accelerated EBCD; this methodology could be used across hospital stroke units to assist staff and other stakeholders to co-design and implement improvement plans.

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