Altering the Rehabilitation Environment to Improve Stroke Survivor Activity (AREISSA): A Phase II Trial

This is a Before After Controlled Trial which will compare the activity levels of stroke patients with and without exposure to Environmental Enrichment (EE). EE will involve increased access to activities and equipment which facilitate physical, cognitive and social activities during rehabilitation from stroke in a hospital setting. Before Phase (standard care) – in this period, participants will receive standard rehabilitation therapies within the standard rehabilitation environment for that particular rehabilitation unit. The Before Phase is estimated to last for approximately 9 months or until 26 patients have been recruited to complete the intervention cohort. After the last participant in this phase has been discharged from the rehabilitation unit, the Implementation Phase will begin. Implementation Phase- during this phase the participating rehabilitation unit will no longer recruit patients. They will be provided with the AREISSA Protocol for enrichment and Environmental Enrichment equipment. The Protocol and equipment aims to encourage patients to engage in physical, cognitive and social activity during non-therapy times throughout their entire waking hours. Accompanying this Protocol and enrichment equipment will be an Implementation package and support from the research team as outlined in the below After Phase section. The Implementation Phase will last for approximately 3 months. The time allocated to enhance embedding of this intervention in a busy rehabilitation unit.The After (intervention)Phase will begin at the end of this 3 months. After Phase (intervention-Environmental Enrichment) – in this period, all participants will have access to both individual and communal forms of Environmental Enrichment for the duration of their stay in the rehabilitation unit. In addition to standard rehabilitation therapies delivered on the unit, participants will be given access to a communal enrichment area which will include computer with internet connection, reading material (fiction and non-fiction books, coffee table books, newspapers), jigsaw puzzles, board games and a dining area for eating meals. Individual enrichment will involve the provision of activities of the participant’s choice including music, audio books, books, word and number puzzles and board games. Family members of participants will be encouraged to bring in hobbies and activities that participants enjoyed prior to their stroke. Participants will have explained the benefits of undertaking activity after stroke and will be advised of daily targets to aim for. Rehabilitation team members will be advised to encourage participants to attend the communal enrichment area or make use of their individual enrichment activities which will be available in satchels located at their bedside. Additionally, team members will be advised to encourage the participants to utilise the enrichment activities provided to them if the participant is seen to be inactive. At no stage will the participants be coerced into utilising the enrichment equipment and activities. They will be used at the discretion of the participants. In both the Before (control) and After (intervention) phase, patients will be advised they are in a study investigating the effect that the surrounding environment has on stroke survivor recovery. There will be no mention of ‘environmental enrichment’. The After Phase will similarly last for 9 months or until 26 patients have been recruited to complete the intervention cohort. Implementation While the Environmental Enrichment model is largely patient driven, clinicians must support the change in the unit and provide patients with assistance when needed. Targeted implementation strategies will be used to help embed the intervention within the unit. Staff will be supported to promote the EE activities using the following evidence-based strategies: (i) education (ii) Enrichment Champions (iii) audit and feedback and (iv) site support (visits from the Trial Coordinator and regular phone and email contact).