A multidisciplinary intensive mobility program for community dwelling stroke survivors

This thesis explores the implementation of a novel intensive mobility program for community dwelling stroke survivors involving a multidisciplinary team and selfmanagement approach.

Interventions aimed at increasing amounts of practice after stroke are known to improve functional outcomes such as mobility. Recently there has been a drive to quantify dosage of practice more accurately in stroke rehabilitation to better determine the effect of practice on functional outcomes. This is particularly pertinent in community settings, which do not commonly provide higher intensity rehabilitation when compared to acute or sub-acute rehabilitation settings. Traditionally, previous methods to increase practice in rehabilitation have included the use of additional therapy sessions, semi supervised practice, circuit, and group training and self-directed (independent) practice. Recently there has been more interest in structured intensive programs to increase the amount of practice completed in rehabilitation settings. The success of more intensive programs suggests they may be worth investigating later after stroke and to improve mobility outcomes in community dwelling populations.

To date, there have been only a small number of more intensive mobility programs offered to people after stroke, with little research into the feasibility of implementing intensive programs in the community. Programs which are developed for community rehabilitation should consider the unique needs and barriers of community dwelling stroke survivors and consider the complex relationship with function and self-management in the long term. While community dwelling stroke survivors generally exhibit high adherence to standard therapy programs, little is known about their adherence and the acceptability of more intensive mobility programs. Therefore, an implementation study was completed to investigate the feasibility of implementing an intensive mobility program for community dwelling stroke survivors. The program was delivered by a multidisciplinary team which included physiotherapy, occupational therapy and exercise physiology and included an embedded selfmanagement program.

The findings of the study show that an intensive mobility program can be delivered feasibly to community dwelling stroke survivors with high adherence and acceptability. The study also shows that clinical outcomes observed after participating in an intensive mobility program are promising and warrant further investigation.

The intervention was able to be implemented successfully due to use of effective knowledge translation within the multidisciplinary team, including strategies to facilitate regular and ongoing communication, as well as clinical and participant resources. Future research should consider the use of clinical outcome measures, the setting of rehabilitation and the receptivity of participants.