Stroke Therapy

Name of project:

The “BEST” study – Best Evidence for Stroke Therapy

Lead Local Health District

Murrumbidgee

Research Project

Removing barriers to evidence translation: facilitating clinician and patient uptake of evidence-based stroke rehabilitation.

Adults living in rural communities’ post-stroke experience variable and often restricted access to rehabilitation services with traditional centre-based models of care unable to consistently meet the needs of this population. Limited evidence indicates that a self-management model may offer an alternative service delivery option, however this approach had not been trialled with a stroke specific population.

The identified inequity in access to stroke rehabilitation for adults living in rural areas post stroke, in addition to the critically low translation of evidence-based stroke guidelines into clinical practice, led to the clinical research collaboration between Albury Wodonga Health, Murrumbidgee Local Health District and Charles Sturt University. The research team aimed to determine;

1) What self-management resources patients with stroke and their families require to implement an effective rehabilitation program at home.

2) What education and support clinicians need to better understand current stroke evidence and to “package” this best practice intervention into self-management models for patients with stroke.

Focus groups with patients post-stroke, their families and occupational therapists identified key supports and information to inform the development of the self-management program, website with online and print resources, strategies to support clinicians to translate evidence into clinical practice, including “how to” videos, fact sheets, education and training.

Participants were recruited into the 12-week program whilst also receiving ‘usual care’ such that participation in the project sought to enhance the participant’s care. Week 1-6 involved weekly phone sessions focussed on goal setting using occupational therapy coaching techniques. Throughout weeks 6-12 participants continued with the self-management approach, supported by ongoing access to website resources. At week 12 baseline outcomes were repeated, primary measures evaluated goal achievement, everyday functional performance, participation and self-efficacy.

The project is currently in the final stages of data collection and analysis. Preliminary findings demonstrate significant improvement in all targeted areas of impairment, function, participation and self-efficacy. Clinician confidence translating evidence to practice is currently being analysed.

The BEST study demonstrates self-management programs offer an effective rehabilitation approach to improve outcomes post-stroke for adults in rural communities. Strategies and support to further implement and sustain this model state-wide are being considered.

Project team:

  • Dr Melissa Nott – Charles Sturt University
  • Dr Leah Wiseman – Albury Wodonga Health
  • Shannon Pike – Murrumbidgee Local Health District
  • Tanya Seymour – Albury Wodonga Health
  • Tana Cuming – Chares Sturt University.

Contact:

Dr Melissa Nott – mnott@csu.edu.au                             
Dr Leah Wiseman – Leah.Wiseman@awh.org.au