Implementation and evaluation of a stroke circuit class in a regional community setting

<p dir="ltr">This thesis describes the development, delivery and evaluation of a tailored implementation intervention to sustain a stroke circuit class for community participants in a regional hospital setting. Circuit classes improve mobility for people with stroke and are strongly recommended in the Stroke Foundation Clinical Guidelines for Stroke Management. There are numerous challenges to participation in ongoing exercise programs for people with stroke after hospital discharge. Circuit classes address some of the challenges by providing a cost-effective mode of participating in exercise in the longer term. Further, the social nature of a class may improve the psychosocial wellbeing of people with stroke. Despite these benefits, circuit classes were observed not to be routinely conducted for community patients in a regional hospital setting in Victoria, Australia. </p><p dir="ltr">The study described in this thesis used an implementation and evaluation design guided by the Knowledge to Action framework. First, a retrospective audit of healthcare records was conducted to identify practice gaps in circuit class delivery. Next, focus groups and an online survey were conducted based on the Theoretical Domains Framework and the Normalisation Measure Development Questionnaire to identify healthcare professionals’ barriers and facilitators to circuit class delivery. Implementation interventions were then designed to address the identified barriers and were put in place over a 6-month period. Additionally, clinical outcomes were measured before and after circuit class participation. Finally, an evaluation was conducted after the implementation intervention period to evaluate circuit class sustainability. </p><p dir="ltr">In summary, the study presented in this thesis demonstrated that a tailored implementation intervention can increase circuit class attendance and enhance sustainability in a regional setting. Further, mobility outcomes and goal attainment for people with stroke were observed to change positively after class participation. The study presented in this thesis identified specific barriers the health professionals reported to conducting the classes including insufficient training and a lack of confidence. These barriers informed the design of a tailored intervention that included training, role modelling and audit and feedback. The intervention successfully addressed the perceived barriers of the healthcare professionals and contributed to the sustainability of the circuit class. The methodology used in the study presented in this thesis provides a potential framework that could be replicated in other regional healthcare services and merits further investigation.</p>