Piloting the “Stepping On after Stroke” falls prevention program for community stroke survivors in Singapore: A feasibility study

Study period: November 2016 – July 2017 * Subject recruitment will start only when IRB approves. * Intervention will be from November 2016 to January 2017. * Follow up period will be from January 2017 to July 2017. Clinic sites for conducting this study: 1. Wellness Center, Alexandra Health System (Singapore) 2. SPD Day Rehabilitation Center (Singapore) Stepping On leader training workshop This is a 1.5-day face-to-face group-based training workshop conducted by master trainer Mr Xu Tianma (Principal Investigator)(PI) for allied health professionals in Singapore to become qualified Stepping On program leaders. It provides them with the basic knowledge of Stepping on program in preparation for setting up the group based Stepping On programs for community older adults. The participant will learn the key elements of the program and basic skills in facilitating the groups by participating in role play sessions during the workshop in a classroom setting. Ankle weights will be used to demonstrate the upgrading of exercises during the role play sessions. Stepping On after Stroke leader training workshop This is an add-on training workshop to any Stepping On leaders who have completed the 1.5 days Stepping On leader training. It will be a face-to-face group-based training by master trainer Xu. Additional components to Stepping On program will be shared at the half day workshop. Role play will be conducted by trainees and facilitated by the master trainer. No other physical equipment will be needed except ankle weights for muscle strengthening exercises during the workshop. About master trainer The Stepping On leader training workshops are facilitated by Mr Xu Tianma who is the PI for this research project. Mr Xu is an occupational therapist (OT) with more than 15 years of clinical experience working with older adults and stroke population. He teaches the OT degree program in Singapore Institute of Technology. He has conducted many training sessions to healthcare professionals in the areas of falls prevention, and stroke rehabilitation. He has successfully conducted two Stepping On Leader Training Workshops in March and April 2016. Mr Xu is currently pursuing his PhD study with University of Sydney under Professor Lindy Clemson, the main author of Stepping On program. Staff involved: Stepping On after Stroke program leaders At least one OT and/or one physiotherapist(PT) from the participating rehabilitation center who have successfully completed the Stepping On facilitator training will be invited to join the half-day Stepping on after Stroke program leader training workshop. They will become Stepping On after Stroke program leaders in facilitating the program during the study. Onsite clinical coordinators There will be at least one therapist from each participating center to be appointed as onsite clinical coordinator to coordinate the participant recruitment and weekly sessions. Invited guest speakers External eye specialist and pharmacist will be invited as guest speakers to give a short session to stroke participants on common eye conditions in people after stroke in week 5 and medications and falls after stroke in week 6 respectively. The estimated time allocated for each expert will be 30 - 45 minutes. Program outline Pre-intervention evaluation will be conducted by the trained assessors at baseline using the series of standardized outcome measures. Each assessment session will last about one hour for each participant. 7 weeks intervention -Weekly session will be scheduled on weekdays at a comfortable time slot that suits the participants and the center. -Each group session will be run in an enclosed environment. -There will be one 2-hourly group session facilitated by a qualified Stepping On after Stroke program leader in each week for 7 weeks. -Each session consists of 20-30 minutes balance and strengthening exercises led by physiotherapist and facilitator. -Domestic helpers or caregivers are encouraged to join the weekly session with the stroke participants. -Each participant will receive one additional supervised community mobility practice session in a smaller group on top of the big group outing in week 5. -Each participant will be provided with weekly program handouts and a communication booklet and weekly homework sheet at each session. -The homework sheet will include Balance exercises & Strengthening exercises that each participant needs to tick daily once completed. Two additional educational sessions will be conducted for family members and domestic helpers in the 1st and 7th week. Each educational session will last for 2 hours. OT will share the program overview, nature of stroke, community resources, common falls prevention strategies with all family members and helpers. OT will discuss with all participants about their supporting role in preventing their loved ones from falling in the community. Follow-up home visit OT will contact each participant to arrange for home visit 4-6 weeks after the 7th session. It aims to follow through of preventive strategies and assist with home modifications. Phone call will be a back-up option if home visit is not possible. All participants and program leaders will be invited to fill up the program evaluation survey form after the home visit. Post-intervention reevaluation -Same outcome measures will be conducted after the home visit. -All participants and program leaders will be invited to fill up the program evaluation survey form after the home visit. 3-month booster session -All participants will be invited to join the 2-hour booster group session at 3 months after 7th session. -Facilitator and PT will review and conduct group exercise for 20 minutes. -During the session, every stroke participant and family members or helper will share with each other how they benefited from the program, such as their self-coping and falls prevention strategies, as well as challenges faced since the completion of the 7 weeks program. -Program evaluation survey will be issued to all participants again for their feedback after the booster session. 6-month follow-up -All stroke participants will be followed up for a period of 6 months after 7th session. -Each participant will be asked to keep track of their fall incidents (if any) during the 7 weeks program and 6 months after the 7th session. -Each participant will be asked to fill up the monthly fall calendar provided by the researcher and submit it to the onsite clinical coordinator or the researcher at the beginning of the following month. Family members and helpers will be encouraged to assist the stroke participant in this activity. Researchers will remind them by phone call if the monthly fall calendar is not returned on time. Fidelity check The PI Xu will conduct the fidelity check in week 3-5 to ensure the interventions are carried out as planned. Feedback will be given to the program leaders in each center after each fidelity check.