Arming Our Patients: empowering patients to increase self-directed upper-limb activity at the Oxfordshire Stroke Rehabilitation Unit

Purpose

The Oxfordshire Stroke Rehabilitation Unit (OSRU) is a 20-bed inpatient service, delivering specialist rehabilitation to patients following acute stroke. A review of current practice highlighted patients spending a large amount of time inactive and limited number of self-directed exercise programmes being provided. Barriers were identified including insufficient resources and inconsistent local processes. A service development project was initiated to establish a standardised approach to provision of self-directed resources for upper limb impairment, and increase self-directed upper limb rehabilitation within the service.

31% of patients
with an upper limb impairment had a self-directed exercise programme

Approach

OSRU Occupational Therapists and Physiotherapists were surveyed to scope current provision of upper limb programmes, and how often these were reviewed. Patients at OSRU were also surveyed to establish if a self-directed programme was provided, how helpful these were and how important their upper limb recovery was to them. A series of actions were developed by the working party: - Develop a local pathway for self-directed upper limb rehabilitation - Staff training to embed use of pathway within service - Improve quality and accessibility of upper limb resources - As part of pathway, embed use of Constraint Induced Movement Therapy (CIMT) within the service - Multidisciplinary training on strategies to encourage self-directed practise - Explore use of assistive technology e.g. phone apps or videos - Implementation of self-directed upper limb groups A time frame of six months was set for project completion, with a repeat staff and patient survey to be conducted in September.

Outcomes

Results: Of 16 patients who were able to complete the survey, initial results showed 31% of patients with an upper limb impairment had a self-directed exercise programme and 7 patients rated their arm as 5 (very important) to get better. The staff survey highlighted only one training session was provided with family/carers, and exercises were on average only reviewed once during admission. Post implementation results will be collated in September.

Conclusion(s): Patients at OSRU rate upper limb recovery as very important but are currently not sufficiently equipped with resources and exercise programmes to maximise self-directed activity. There is a lack of timely review of programmes prescribed and limited family/carer involvement. It is hoped the service improvement project will standardise therapist’s approach and increase self-directed upper limb rehabilitation.

Cost and savings

Not applicable. 

Implications

Staff at OSRU will have a clear pathway to follow for patient’s presenting with upper limb impairment. This pathway will maximise patient’s opportunity for self-directed rehabilitation. It is hoped patients will feel empowered to take a more pro-active, self-directed approach to their rehabilitation as they transition into the community.

Top three learning points

No further information. 

Funding acknowledgements

None.