Targeted rehabilitation approach could improve physical capabilities in stroke patients

People who have become housebound after having a stroke are being invited to take part in a major new study that could help to put them back on the road to independence.

Researchers at The University of Nottingham are leading a national research project that will look at whether a new way of offering rehabilitation therapy could assist stroke patients who are keen to leave the house more but may have lost the confidence to step out on their own.

Funded with £10 million from the National Institute for Health Research (HIHR), the study will involve providing some volunteer patients with a targeted rehabilitation approach and goal-based outdoor mobility programme in an attempt to improve their physical capabilities and boost their belief in their own abilities. Their achievements will then be compared to other volunteer patients who have not received the intervention to discover how they fared in comparison.

Dr Pip Logan in the University's Division of Rehabilitation and Ageing, who is leading the study, said: "Looking at practical barriers which may be preventing people from leaving the house, such as a lack of adequate handrails on steps and garden paths, is of course very valid.

"However, it is often the psychological barriers which are the toughest to overcome. For someone who has driven all their life up until their stroke, tackling public transport can seem extremely daunting. Similarly, someone left with cognitive issues following stroke, such as memory loss or aphasia, may worry about their ability to communicate effectively while out and about.

"We are hoping that by offering a more targeted approach to therapy we can help them to develop their mobility abilities and coping strategies that will allow them get about more and become independent people once again."

The research follows a pilot study undertaken by the team in 2004 which found that, despite rehabilitation, 42 per cent of people with a stroke wanted to get out of their house more. The randomised controlled trial offered a travel promotion programme by an occupational therapist to half of the volunteers on the study. It provided them with bespoke information, prescribing remedial exercises and equipment as needed and supporting them in their return to driving or using public transport. At the end of the four month trial, this group were twice as likely to get out and about as those who had not received this service.

The researchers are now keen to recruit more than 150 stroke patients from across Nottinghamshire to take part in the trial and have been joining forces with local authorities, health agencies and a national charity to find suitable volunteers.

Local GPs, Nottingham City Council, the Stroke Association and the NHS Nottinghamshire County primary care trust's stroke register are playing their part in identifying patients who may have fallen through the net. Support from NHS Nottingham City primary care trust and Nottinghamshire County NHS Trust will come in the form of occupational therapist Lorraine Lancaster, who will spend four days a week on the project, travelling around Nottinghamshire visiting patients in the intervention group that will be receiving the bespoke therapy intervention.

Lorraine works as an occupational therapist with the Nottingham City Community Stroke team. This team provides rehabilitation and mid to long term support, mostly at home, for people who have had a stroke.

Lorraine said: "Our multi disciplinary team has specialist knowledge and experience of stroke and stroke related issues.  It is important to work with patients, families and carers to develop a rehabilitation programme in order to meet their individual needs. Patients in this research study build on the work we have achieved by specifically focusing on outdoor mobility. We welcome any research that provides robust evidence that a specific intervention is likely to benefit stroke survivors."