Exercise after stroke. Vision More people after stroke, more active more often, exercising safely and effectively.

Transcription

1 Exercise after stroke Vision More people after stroke, more active more often, exercising safely and effectively.

2 Who are we! Community exercise team, HL&S Blackburn with Darwen BC Community stroke rehab team - NHS Blackburn Adult Social Services - Blackburn with Darwen BC

3 Facts and figures about stroke Stroke has a greater disability impact than any other chronic disease. Over 300,000 people are living with moderate to severe disabilities as a result of stroke [5] An estimated 150,000 people have a stroke in the UK each year [1] There are over 67,000 deaths due to stroke each year in the UK [2] Stroke is the third most common cause of death in England and Wales, after heart disease and cancer [3]

4 Increasing body of literature showing that exercise is of benefit to people after stroke [1-4] Exercise improves physical fitness and physical function (particularly walking ability) - reduces disability Exercise, may also - improving mood, and reducing the risk of recurrent stroke and other vascular events Anecdotally, people after stroke who have participated in exercise programmes say: exercise reduces fatigue increases confidence improves quality of life

5 Physical fitness training after stroke Review of 12 randomised trials - n = 289 patients Suggest that there may be benefits for: Strength Disability Mobility walking speed, endurance Balance Cochrane Systematic Review (Saunders et al 2004)

6 Access to exercise and physical fitness training after stroke Programme design evidence-based Simple Functional Do-able exercises graded Do-able regime Enjoyable and varied Appropriate location Challenging Evaluation prospective, observational, cohort study Referral

7 Pathways Community Stroke rehab team (NHS Blackburn with Darwen) Falls Prevention and rehabilitation programme (Blackburn with Darwen) Exercise After Stroke Community Session Specialist supported Gym sessions Specialist supported Swim sessions Specialist Walks & Cycling sessions Specialist Community exercise sessions Community Activity sessions e g Allotments & Re fresh

8 Funding Dept of health recurrent over three years starting from 2008/9. Blackburn allocations = First year spent on training and setting cost 2009/10 funding allocated to develop specialist speech and language intervention Finance under local authority financial constraints spend allocation through steering group

9 Training Aim to enable Specialist Exercise Instructors and other suitably qualified staff (e.g. Physiotherapists) to design, implement and evaluate physical activity programme for people after stroke that are safe, effective, appropriate and enjoyable, based on current evidence, and in accordance with the relevant clinical guidelines, national service frameworks, national occupational standards and educational standards

10 The course - 20-credits (SCQF level 8 / BSc [Hons] level 2) 200 study hours - inc. lectures, tutorials and practical workshops. The patient pathway from acute stroke on to rehabilitation and subsequent referral into community exercise Highlighting the role of the specialist exercise instructor in patient assessment, exercise design and delivery, evaluation of output / outcomes And most importantly the role of all within a multidisciplinary team.

11 Key topics inc. the pathology of stroke the input of the multidisciplinary team in the management of stroke fitness levels after stroke and its impact on function evidence for physical activity after stroke and the impact of physical activity on risk factors in stroke indications and contra-indications to exercise after stroke; clinical guidelines the implications of co-morbidities and medications on exercise performance motivation and communication strategies aimed at improving health behaviour relevant professional standards pertaining to ethical issues including; confidentiality and risk management and national service frameworks

12 Rehabilitation model - falls prevention Referrals from G P;s and other health professionals Initial home assessment /screening One to one home exercise Otago (specialist session) PSI (postural stability instructed session) Falls prevention Specialist Gym sessions Re Fresh community based sessions, e g walks, Cycling, seated or low impact aerobics, allotments.

13 Funding and delivery Funded by: NHS Blackburn with Darwen Delivered by: Community exercise team, HL&S Blackburn with Darwen BC

14 Using a sample group of 18 clients who have received the one-to-one home exercise programme, we obtained the following results:

15 Outcome Measures FES-I (falls efficacy scale international) The Warwick Edinburgh mental well being scale Timed sit to stand

16 FOF - Total mean score comparisons FES-I % decrease in total mean FES-I scores p< at week 1 at week 6

17 FOF individual constructs Walking on a slippery surface - lowest mean change Visiting friends or relatives & getting in and out of a chair showed the greatest mean change Statistical significance p<0.001

18 Mean Score Comparisons WEMWB scale 18% increase in total mean mental well-being scores p< at week 1 at week 6

19 Mental well-being individual construct outcomes Statistical significance (p 0.05) within 12 of the 14 paired items Greatest mean change - Item 13 (I ve been interested in new things) & Item 3 (I ve been feeling relaxed) at and -1 respectively Lowest mean change - Item 1 (I ve been feeling optimistic about the future) and Item 12 (I ve been feeling loved) at and respectively

20 Mean score comparisons STS assessment % increase in total mean STS number p=0.001 at week 1 at week 6

21 Individual STS outcomes Number of completed cycles Individuals Week 1 Week 6

22 Feel good factor The exercise programme has given me the confidence to book a holiday. I m going on a cruise to Norway; I m 96 (years old) The exercise programme really helped with my confidence. I now enjoy baking again and being able to wash and dress myself is a big plus: I'm walking much better

23 Typical Community falls session

24 What we have What We Want

25 Contact Melanie Passerini blackburn.gov.uk or Katherine Wilcock