Could rehabilitation exercise videos (real patients exercising under the guidance of an experienced physiotherapist) be given as part of standard care by health care professionals (HCPs) to people with stroke (PwS) prior to discharge from the hospital, and would PwS adhere to physical exercises and rehabilitation and improve functional outcomes by using the videos at home?

Funding:

BNSSG ICB Research Capability Funding.

What is the problem?

Exercise after stroke has lots of benefits. It can help the heart and lungs to work better, for some people it can help them walk better and for others it can make their arms stronger and better able to do day-to-day tasks. Importantly it can prevent further stroke. However, after discharge from the hospital, 3 out of 4 stroke survivors become inactive and do less exercise and social activities. Many people report feeling afraid and unsupported, and carers report feelings of abandonment following discharge from the hospital.

Clinical guidelines for stroke recommend that people with stroke (PwS) should complete at least 3 hours of rehabilitation every day. They should be provided with resources to help them practice on their own and also for carers to support them. To help stroke survivors, we need exercise resources that are suitable for their needs and are designed based on these.

Since 2016, Kumar has been delivering group exercises classes (Next Steps) for PwS with the charity Bristol After Stroke (BAS). As PwS felt abandoned after the classes ended, they suggested that we develop short bite-size videos to watch at home.  We created videos in English which participants at Next Steps and BAS events said were helpful, engaging, and helped their movement and independence. They liked them because they show real patients exercising with support from a physiotherapist, and they included a range of exercises for patients who had different abilities.  We have applied for funding from the NIHR to make the video more inclusive by making them available in other languages such as Hindi, Gujrati, Bengali.

 

What is the aim of the research?

In this project, we would like to see if the rehabilitation exercise videos developed as part of our Next Steps initiative can be given in hospital by Health Care Professionals (HCPs) to PwS prior to discharge. Once discharged, we will find out the extent to which PwS adhere to physical exercise and rehabilitation by using these exercise videos at home. This will enable us to focus effort to optimise factors that will promote ongoing engagement with the video resource and identify the most appropriate design(s) for wider intervention delivery and a future efficacy trial.

 

How will this be achieved?

During our study we will:

1. Conduct interviews with PwS, their family-members/carers and clinicians (physiotherapists) to discuss the video content and if required refine videos based on their feedback. For this purpose, our existing videos in the English language will be shared with the participants. Our patient group will include a range of patients (based on age, gender, disability (mild and moderate stroke) and ethnicity.
2. Ask the staff at a range of stroke units in the Southwest region to introduce the exercise videos to PwS prior to discharge from hospital. We will develop mode of implementation on the ward by training the therapists to deliver post-discharge materials. We will then follow-up PwS at 3 and 6 months to find out if they are using the videos and engaging in the exercises. We will conduct workshops to understand: do people engage with the videos?; how long do they do it for?; what are the facilitators?;, if they do not, what are the barriers?
3. Conduct workshops with service commissioners, charity partners, HCPs, and patient partners to discuss findings from 1 and 2 above, and discuss ideas for future work / implementation / trial.

Who is leading the research?

Dr Praveen Kumar, Senior Lecturer in Physiotherapy , University of the West of England.

Further information

About Dr Praveen Kumar.

For more information or to get involved with this project, please contact bnssg.research@nhs.net.