The effect of an enriched environment on activity levels in people with stroke in an acute stroke unit: protocol for a before-after pilot study

Objectives: To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute stroke patients and reduce adverse events. Design: Controlled before–after pilot study. Setting: An acute stroke unit in a regional Australian hospital. Participants: Acute stroke patients admitted during (a) initial usual care control period, (b) an enriched environment period and (c) a sustainability period. Intervention: Usual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing and daily group activities. Change management strategies were used to implement an enriched environment within existing staffing levels. Main Measures: Behavioural mapping was used to estimate patient activity levels across groups. Participants were observed every 10 minutes between 7.30 am and 7.30 pm within the first 10 days after stroke. Adverse and serious adverse events were recorded using a clinical registry. Results: The enriched environment group ( n = 30, mean age 76.7 ± 12.1) spent a significantly higher proportion of their day engaged in ‘any’ activity (71% vs. 58%, P = 0.005) compared to the usual care group ( n = 30, mean age 76.0 ± 12.8). They were more active in physical (33% vs. 22%, P < 0.001), social (40% vs. 29%, P = 0.007) and cognitive domains (59% vs. 45%, P = 0.002) and changes were sustained six months post implementation. The enriched group experienced significantly fewer adverse events (0.4 ± 0.7 vs.1.3 ± 1.6, P = 0.001), with no differences found in serious adverse events (0.5 ± 1.6 vs.1.0 ± 2.0, P = 0.309). Conclusions: Embedding an enriched environment in an acute stroke unit increased activity in stroke patients.

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Feasibility of creating an enriched environment and subsequent impact on activity levels for stroke patients in an acute stroke unit

10.14264/uql.2019.177 ◽

2019 ◽

Author(s):

Ingrid Rosbergen-Wildemors

Keyword(s):

Acute Stroke ◽

Stroke Unit ◽

Enriched Environment ◽

Activity Levels ◽

Stroke Patients ◽

Acute Stroke Unit

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The impact of environmental enrichment in an acute stroke unit on how and when patients undertake activities

Clinical Rehabilitation ◽

10.1177/0269215518820087 ◽

2018 ◽

Vol 33 (4) ◽

pp. 784-795 ◽

Cited By ~ 8

Author(s):

Ingrid CM Rosbergen ◽

Rohan S Grimley ◽

Kathryn S Hayward ◽

Sandra G Brauer

Keyword(s):

Acute Stroke ◽

Stroke Unit ◽

Environmental Enrichment ◽

Control Group ◽

Activity Levels ◽

Stroke Patients ◽

Group Activities ◽

Acute Stroke Unit ◽

Communal Areas ◽

The Impact

Objectives: To explore the effect of environmental enrichment within an acute stroke unit on how and when patients undertake activities, and the amount of staff assistance provided, compared with a control environment (no enrichment). Design: This is a substudy of a controlled before–after observational study. Setting: The study was conducted in an Australian acute stroke unit. Participants: The study included stroke patients admitted to (1) control and (2) environmental enrichment period. Intervention: The control group received standard therapy and nursing care, which was delivered one-on-one in the participants’ bedroom or a communal gym. The enriched group received stimulating resources and communal areas for mealtimes, socializing and group activities. Furthermore, participants and families were encouraged to increase patient activity outside therapy hours. Main measures: Behavioral mapping was performed every 10 minutes between 7.30 a.m. and 7.30 p.m. on weekdays and weekends to estimate activity levels. We compared activity levels during specified time periods, nature of activities observed and amount of staff assistance provided during patient activities across both groups. Results: Higher activity levels in the enriched group ( n = 30, mean age 76.7 ± 12.1) occurred during periods of scheduled communal activity ( P < 0.001), weekday non-scheduled activity ( P = 0.007) and weekends ( P = 0.018) when compared to the control group ( n = 30, mean age 76.0 ± 12.8), but no differences were observed on weekdays after 5 p.m. ( P = 0.324). The enriched group spent more time on upper limb ( P < 0.001), communal socializing ( P < 0.001), listening ( P = 0.007) and iPad activities ( P = 0.002). No difference in total staff assistance during activities was observed ( P = 0.055). Conclusion: Communal activities and environmental resources were important contributors to greater activity within the enriched acute stroke unit.

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An observational study of physical activity levels on the acute stroke unit of a large teaching hospital in Dublin, Ireland

Physiotherapy ◽

10.1016/j.physio.2015.03.2010 ◽

2015 ◽

Vol 101 ◽

pp. e1110-e1111

Author(s):

O. O’Keeffe ◽

H. Kavanagh ◽

C. Egan ◽

N. Murphy ◽

J. Harbison

Keyword(s):

Physical Activity ◽

Observational Study ◽

Acute Stroke ◽

Teaching Hospital ◽

Stroke Unit ◽

Activity Levels ◽

Large Teaching Hospital ◽

Physical Activity Levels ◽

Acute Stroke Unit

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Qualitative investigation of the perceptions and experiences of nursing and allied health professionals involved in the implementation of an enriched environment in an Australian acute stroke unit

BMJ Open ◽

10.1136/bmjopen-2017-018226 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018226 ◽

Cited By ~ 4

Author(s):

Ingrid C M Rosbergen ◽

Sandra G Brauer ◽

Sarah Fitzhenry ◽

Rohan S Grimley ◽

Kathryn S Hayward

Keyword(s):

Change Management ◽

Acute Stroke ◽

Health Professionals ◽

Stroke Unit ◽

Allied Health ◽

Management Strategies ◽

Enriched Environment ◽

Allied Health Professionals ◽

Acute Stroke Unit ◽

The Impact

ObjectiveAn enriched environment embedded in an acute stroke unit can increase activity levels of patients who had stroke, with changes sustained 6 months post-implementation. The objective of this study was to understand perceptions and experiences of nursing and allied health professionals involved in implementing an enriched environment in an acute stroke unit.DesignA descriptive qualitative approach.SettingAn acute stroke unit in a regional Australian hospital.ParticipantsWe purposively recruited three allied health and seven nursing professionals involved in the delivery of the enriched environment. Face-to-face, semistructured interviews were conducted 8 weeks post-completion of the enriched environment study. One independent researcher completed all interviews. Voice-recorded interviews were transcribed verbatim and analysed by three researchers using a thematic approach to identify main themes.ResultsThree themes were identified. First, staff perceived that ‘the road to recovery had started’ for patients. An enriched environment was described to shift the focus to recovery in the acute setting, which was experienced through increased patient activity, greater psychological well-being and empowering patients and families. Second, ‘it takes a team’ to successfully create an enriched environment. Integral to building the team were positive interdisciplinary team dynamics and education. The impact of the enriched environment on workload was diversely experienced by staff. Third, ‘keeping it going’ was perceived to be challenging. Staff reflected that changing work routines was difficult. Contextual factors such as a supportive physical environment and variety in individual enrichment opportunities were indicated to enhance implementation. Key to sustaining change was consistency in staff and use of change management strategies.ConclusionInvestigating staff perceptions and experiences of an enrichment model in an acute stroke unit highlighted the need for effective teamwork. To facilitate staff in their new work practice, careful selection of change management strategies are critical to support clinical translation of an enriched environment.Trial registration numberANZCTN12614000679684; Results.

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