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Pasha S, Shepley MM. A Structured Literature Review on the Research and Design of Rehabilitation Environments. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241248604. [PMID: 38742748 DOI: 10.1177/19375867241248604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
AIM This literature review is conducted to identify knowledge gaps and shape a framework for the development of guidelines and future research on programming and design of rehabilitation environments. BACKGROUND Patients suffering from trauma, stroke, neurological or cardiopulmonary conditions, or recovering from surgery or cancer treatment require rehabilitation services. A comprehensive rehabilitation program can support continuum of care for inpatient and outpatient groups. However, within most facilities, rehabilitation environments are found to be outdated and undersized compared to other programs or lack the correct adjacencies within the facility. Unfortunately, this deficiency is echoed by limited guidelines on programming, planning, and design of these environments. General guidelines derived from healthcare environments research is not adaptable to rehabilitation environments, because the paradigm used in most healthcare environment research does not address specific needs of rehabilitation patients in regaining confidence or relearning daily life skills. METHOD We conducted a structured literature review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a basis for reporting the available body of work on evidence-based research in rehabilitation environments. RESULT AND CONCLUSION Through analysis of the limited literature, specific mediators such as patient confidence and motivation were identified. An environment that creates a balance between privacy and social interaction can promote these mediators. Creating enriched environments through elements that engage the senses and encourage more social and physical interaction is essential for recovery. Finally, accessibility and wayfinding are of great importance in these environments due to potential limited mobility or cognitive impairments of patients.
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Annemans M, Van Dyck D, Heylighen A. How does the built environment affect patient safety in relation to physical activity? Experiences at a rehabilitation center. APPLIED ERGONOMICS 2024; 116:104214. [PMID: 38199199 DOI: 10.1016/j.apergo.2023.104214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024]
Abstract
Physical activity benefits patients in rehabilitation yet comes with various safety issues. The built environment impacts on both safety and physical activity. We aim to explore the role of the built environment in safety issues related to being physically active in rehabilitation. We conducted a case study at a free-standing rehabilitation center for patients with Multiple Sclerosis, neurologic, or locomotor issues. Patients participated in two interviews supported by activity tracking data. Care professionals participated in focus group interviews respectively with two therapists and four head nurses. Accessibility and physical barriers, visual connections and (in)dependence, and spatial familiarity are important themes when identifying aspects of the built environment in relation to reducing safety issues patients encounter during physical activity. Raising awareness about each of these among care and design professionals could help them to balance safety issues in relation to physical activity and to communicate about them in a nuanced way.
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Affiliation(s)
- Margo Annemans
- KU Leuven, Department of Architecture, Leuven, Belgium; University of Antwerp, Department of Interior Architecture, Antwerp, Belgium.
| | - Delfien Van Dyck
- Ghent University, Department of Movement and Sport Sciences, Ghent, Belgium.
| | - Ann Heylighen
- KU Leuven, Department of Architecture, Leuven, Belgium.
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Cottrell K, Chapman HM. Acquired brain injury (ABI) survivors' experience of occupation and activity during their inpatient stay: a scoping review. Disabil Rehabil 2023:1-25. [PMID: 37982380 DOI: 10.1080/09638288.2023.2281601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/02/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE This review aimed to characterise and map: (1) what type of evidence and what dominant study characteristics are available regarding acquired brain injury (ABI) survivors' experience of occupation and activity in hospital? (2) How are occupation and activity conceptualised in the literature? (3) How are ABI survivors experiencing occupation and activity while in hospital? (4) What factors create barriers or opportunities for engagement in occupations or activity in hospital? (5) Are there any knowledge gaps identified? MATERIALS AND METHODS A scoping review was conducted examining literature published between 2017 and 2022. Relevant studies were systematically retrieved from electronic databases. RESULTS Thirty-four publications were included. There were more quantitative studies (n = 18). Much of the research has been conducted outside of the UK. The populations studied were principally stroke (n = 22). The concept of activity rather than occupation predominates. Patients spend their time alone and inactive. Structural and contextual barriers for engaging in activity are identified. Qualitative study designs exclude ABI survivors with communication or cognitive impairment. CONCLUSIONS There is a paucity of research with ABI survivors in hospitals in the UK. Alternative methodological approaches such as ethnography would ensure those with communication or cognitive impairment are not excluded from research. Implications for rehabilitationRehabilitation professionals, especially occupational therapists, need to lead acquired brain injury (ABI) research in acute hospital settings in the UK.Conceptualisation of meaningful activity and occupation needs a clearer focus in ABI research.Qualitative studies frequently exclude participants with cognitive or communication impairments so methodologies that are more inclusive and representative of brain injury survivors are needed.
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Affiliation(s)
| | - Hazel M Chapman
- Faculty of Health, Medicine and Society, University of Chester, Chester, UK
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Janssen H, Bird ML, Luker J, Sellar B, Berndt A, Ashby S, McCluskey A, Ada L, Blennerhassett J, Bernhardt J, Spratt NJ. Impairments, and physical design and culture of a rehabilitation unit influence stroke survivor activity: qualitative analysis of rehabilitation staff perceptions. Disabil Rehabil 2022; 44:8436-8441. [PMID: 35113761 DOI: 10.1080/09638288.2021.2019840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to investigate rehabilitation staff perceptions of factors influencing stroke survivor activity outside of dedicated therapy time for the purpose of supporting successful translation of activity promoting interventions in a rehabilitation unit. MATERIALS AND METHODS Purposive sampling of multi-disciplinary teams from four rehabilitation units was performed, and semi-structured interviews were conducted by telephone, digitally audio-recorded and then transcribed verbatim. A stepped iterative process of thematic analysis was employed until data saturation was reached. RESULTS All but one of the 22 participants were female, the majority were either physiotherapists or occupational therapists, with a median of 4 years (interquartile range, 2-10) working at their respective rehabilitation units. Analysis of the data revealed three themes: (i) stroke survivor characteristics influence their activity outside therapy, (ii) the rehabilitation environment influences physical, cognitive, and social activity, and (iii) institutional priorities, staff culture, and attitude can be barriers to activity. Rehabilitation units were perceived to be unstimulating, and visitors considered enablers of activity when resources were perceived to be scarce. CONCLUSIONS Our results suggest careful consideration of the involvement of visitors, an individual's needs and preferences, and the institution's priorities and staff attitude may result in greater stroke survivor activity during rehabilitation.Implications for rehabilitationStaff should consider stroke survivor impairments and a rehabilitation unit's institutional priorities and staff attitudes when aiming to enhance stroke survivor engagement in activity.The physical and social environment of a rehabilitation unit can be optimised by rehabilitation staff to promote activity.Utilisation of visitors of stroke survivors on a rehabilitation unit may be one way to enhance engagement in activity.Discussion within the rehabilitation team concerning "ownership" of the role of supporting stroke survivor activity outside of structured therapy time may support better engagement in same.
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Affiliation(s)
- Heidi Janssen
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute and Hunter New England Local Health District, New Lambton Heights, Australia
| | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Julie Luker
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Ben Sellar
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Angela Berndt
- International Centre for Allied Health Evidence (iCAHE), Adelaide, Australia.,Occupational Therapy Australia (OTA), Fitzroy, Australia
| | - Samantha Ashby
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Annie McCluskey
- School of Health Sciences, The University of Sydney, Sydney, Australia.,The StrokeEd Collaboration, Sydney, Australia
| | - Louise Ada
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | | | - Julie Bernhardt
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Recovery, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne Australia
| | - Neil J Spratt
- School of Biomedical Sciences and Pharmacy, University of Newcastle and Hunter New England Local Health District, New Lambton Heights, Australia
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5
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Kevdzija M, Bozovic-Stamenovic R, Marquardt G. Stroke Patients' Free-Time Activities and Spatial Preferences During Inpatient Recovery in Rehabilitation Centers. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:96-113. [PMID: 35850529 PMCID: PMC9523820 DOI: 10.1177/19375867221113054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives: To investigate which spaces stroke patients visit in their free time while undergoing inpatient recovery in rehabilitation centers, what activities they engage in, and what kind of spaces they want. Background: Research studies consistently show that stroke patients are highly inactive during rehabilitation. Much remains unknown about what patients do in their free time and how the built environment might affect their behavior and activities. Methods: Patients’ free-time activities were recorded via patient shadowing (n = 70, 840 hr), and their spatial preferences were collected using a survey (n = 60) in seven rehabilitation centers. Each participant was observed over one typical day (12 consecutive hours). Their activities, durations, and locations were recorded using floor plans and time log sheets. Results: Six main themes emerged from the analysis of shadowing data and patient surveys: (1) spending most free time in their room, (2) corridor as the overlooked activity hub, (3) food and beverage stations as triggers of activity, (4) wanting to socialize, (5) variety of common spaces for different activities is desired, and (6) common room’s atmosphere, comfort, style, and view are important. Even though socializing with other patients was mentioned as a primary reason for visiting common spaces in the survey, patients spent most of their free time alone. Conclusions: Corridor emerged as a space with great potential to motivate and support various activities of patients. Patients’ free-time activities could contribute to their recovery, and the built environment may play a role in facilitating and supporting these activities.
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Affiliation(s)
- Maja Kevdzija
- Chair for Social and Health Care Buildings and Design, Faculty of Architecture, Technische Universität Dresden, Germany.,Department of Building Theory by Design, Institute of Architecture and Design, Faculty of Architecture and Planning, TU Wien, Vienna, Austria
| | - Ruzica Bozovic-Stamenovic
- Department of Architecture, College of Design and Engineering, National University of Singapore, Singapore
| | - Gesine Marquardt
- Chair for Social and Health Care Buildings and Design, Faculty of Architecture, Technische Universität Dresden, Germany
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Lakhani A, Waters D, Dema S. Evaluating an Inpatient Created Art Installation on Perceptions of the Physical Environment, Health Status, and Rehabilitation Motivation. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:96-111. [PMID: 35038888 DOI: 10.1177/19375867211069297] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES A methodology to assess the impact of involving end users in therapeutic activities to address the hospital physical environment is provided. The impact of participating in a recreational art creation program with the aim of developing an art installation on the immediate feelings of participants and their perception of the physical rehabilitation environment (PPRE) and motivation to participate in rehabilitation (MPR) is investigated. BACKGROUND Rehabilitation unit design has largely excluded the perspectives of end users with disability. Including their aesthetic design contributions moves beyond contemporary approaches where their perspectives are considered. METHODS A two-period, mixed-methods pre-post intervention design involving within and between group comparisons is proposed. During Period 1, program participants and nonparticipants completed admission (T1) and discharge (T2) surveys including PPRE and MPR measures developed by the authors. Surveys pre and post each art session were completed. The art installation will be implemented within unit corridors. Period 2 participants will complete a T1 survey and their physical environment perceptions compared to Period 1 participants. RESULTS Participating in the recreational art program significantly improved immediate levels of calmness, happiness, pain, and physical health. There is a positive relationship between environment perception and rehabilitation motivation. CONCLUSIONS People with disability should be actively involved in healthcare environment design. Arts-based programs have relevance to people with neurological injury as it promotes essential sensory stimulation. The methodology and findings can encourage further work which involves end users in the design of healthcare environments and evaluates the impact of their involvement.
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Affiliation(s)
- Ali Lakhani
- The School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Dan Waters
- Austin Health-Royal Talbot Rehabilitation Centre, Kew, Victoria, Australia
| | - Salvatore Dema
- Austin Health-Royal Talbot Rehabilitation Centre, Kew, Victoria, Australia
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Lipson-Smith R, McLaughlan R. Mapping Healthcare Spaces: A Systematic Scoping Review of Spatial and Behavioral Observation Methods. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:351-374. [PMID: 35356828 DOI: 10.1177/19375867221089702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To provide a taxonomy of spatial observation methods that are commonly used in healthcare environments research and to describe their relative success. BACKGROUND Spatial observation is a valuable but resource intensive research method that is often used in healthcare environments research, but which frequently fails to deliver conclusive results. There is no existing catalog of the different spatial and behavioral observation methods that are used in healthcare design research and their benefits or limitations. METHODS The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ten key databases were searched, and articles were screened by both authors. RESULTS Across 67 included studies, 79 observation methods were reported. We categorized those into four, distinct methodological approaches, outlining the benefits, limitations, and suitability of each for obtaining different types of results. Common limitations included difficulty generalizing to other contexts and a lack of detailed description during data collection which led to key environment variables not being recorded. More concrete conclusions were drawn when observation methods were combined with complimentary methods such as interview. CONCLUSIONS The relative success of spatial observation studies is dependent on the fit of the method selected relative to the research question, approach, and healthcare setting; any complimentary methods delivered alongside it; and the analysis model employed. This article provides researchers with practical advice to guide the appropriate selection of spatial observation methods.
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Affiliation(s)
- Ruby Lipson-Smith
- School of Architecture and the Built Environment, University of Newcastle, Australia
| | - Rebecca McLaughlan
- School of Architecture and the Built Environment, University of Newcastle, Australia.,Sydney School of Architecture, Design & Planning, The University of Sydney, Australia
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Ransolin N, Saurin TA, Zani CM, Rapport F, Formoso CT, Clay-Williams R. The Built Environment Influence on Resilient Healthcare: A Systematic Literature Review of Design Knowledge. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:329-350. [PMID: 35168374 DOI: 10.1177/19375867221077469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to develop built environment (BE) design knowledge to support resilient healthcare by systematically reviewing the evidence-based design (EBD) literature. BACKGROUND Although the EBD literature is vast, it has not made explicit its contribution to resilient healthcare, which is a key component of the highly complex health service. METHOD This review followed the steps recommended by the Preferred Reporting Items for Systematic reviews and Meta-Analyses method. After applying the inclusion and exclusion criteria, 43 journal papers were selected. The papers were analyzed in light of five guidelines for coping with complexity, allowing for the development of BE design knowledge that supports resilient healthcare. RESULTS The design knowledge compiled by the review was structured according to four levels of abstraction: five design-meta principles, corresponding to the five complexity guidelines, seven design principles, 21 design prescriptions, and 58 practical examples. The design knowledge emphasizes the interactions between the BE as physical infrastructure and the functions that it supports. CONCLUSIONS The design knowledge is expected to be useful not only to architects but also to those involved in the functional design of health services as they interact with the BE. Furthermore, our proposal provides a knowledge template that can be continuously updated based on the experience of practitioners and academic research.
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Affiliation(s)
- Natália Ransolin
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Tarcisio Abreu Saurin
- Industrial Engineering and Transportation Department (DEPROT), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Carolina Melecardi Zani
- Bartlett School of Sustainable Construction (BSSC), University College London (UCL), United Kingdom
| | - Frances Rapport
- Australian Institute of Health Innovation (AIHI), Macquarie University, Sydney, New South Wales, Australia
| | - Carlos Torres Formoso
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation (AIHI), Macquarie University, Sydney, New South Wales, Australia
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Kenah K, Bernhardt J, Spratt NJ, Oldmeadow C, Janssen H. Depression and a lack of socialization are associated with high levels of boredom during stroke rehabilitation: An exploratory study using a new conceptual framework. Neuropsychol Rehabil 2022; 33:497-527. [PMID: 35142257 DOI: 10.1080/09602011.2022.2030761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This exploratory sub-study aimed to develop a framework to conceptualize boredom in stroke survivors during inpatient rehabilitation, establish the effect of an activity promotion intervention on boredom, and to investigate factors that are associated with boredom. A framework was developed and explored within a cluster non-randomised controlled trial. Self-reported boredom was measured in 160 stroke survivors 13 (±5) days after rehabilitation admission; 91 participants received usual-care (control) and 69 had access to a patient-driven model of activity promotion (intervention). Individuals with pre-existing dementia or unable to participate in standard rehabilitation were excluded. Hierarchical logistic regression analysis was used to identify demographic, health and activity measures associated with boredom. Results indicated 39% of participants were highly bored. There was no statistically significant difference in boredom levels between treatment groups (difference -11%, 95% CI -26% to 4%). The presence of depression (OR 6.17, 95% CI 2.57-14.79) and lower levels of socialization (OR 0.96, 95% CI 0.92-0.99) predicted high boredom levels. This comprehensive framework provides a foundation for understanding the many interacting factors associated with boredom. Results suggest managing depression and improving opportunities for socialization may support meaningful engagement in rehabilitation to optimize recovery following stroke.
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Affiliation(s)
- Katrina Kenah
- School of Health Sciences, The University of Newcastle, Newcastle, Australia.,Monash Health, Cheltenham, Australia
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, Australia
| | - Neil J Spratt
- Hunter Medical Research Institute, NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The University of Newcastle, Newcastle, Australia.,Department Neurology, John Hunter Hospital, Newcastle, Australia
| | | | - Heidi Janssen
- Hunter Medical Research Institute, NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The University of Newcastle, Newcastle, Australia.,Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia
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McDonald CE, Granger CL, Said CM, Remedios LJ. Seeking Choice to Fulfill Health Literacy Needs: Health Literacy Opportunities for Consumers in Hospital Waiting Areas. QUALITATIVE HEALTH RESEARCH 2022; 32:345-359. [PMID: 34979826 DOI: 10.1177/10497323211051672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this research, we explore and theorize on the potential of hospital outpatient rehabilitation waiting areas to respond and contribute to the health literacy needs of consumers. Constructivist grounded theory informed the sampling and analytical procedures. Thirty-three consumers attending outpatient rehabilitation for a range of health conditions were recruited to this multi-site study. Semi-structured interview and participant observation data were collected and analyzed concurrently using the constant comparison method. The substantive theory of "seeking choice to fulfill health literacy needs" and five interdependent categories were developed. Results indicated that consumers sought choice reflective of their needs; however, the waiting area offered limited choice. Consumers shared ideas to address the lack of choice. Results provide insight into the health literacy needs of consumers in hospital outpatient waiting areas and how health services can appropriately respond to these needs. Future research should investigate the effect of health service environments on health outcomes.
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Affiliation(s)
- Cassie E McDonald
- Physiotherapy, 2281The University of Melbourne, Carlton, VIC, Australia
- Physiotherapy, 90134The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Catherine L Granger
- Physiotherapy, 2281The University of Melbourne, Carlton, VIC, Australia
- Physiotherapy, 90134The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Catherine M Said
- Physiotherapy, 2281The University of Melbourne, Carlton, VIC, Australia
- 95317Western Health, St Albans, VIC, Australia
- 533870Australian Institute of Musculoskeletal Sciences, St Albans, VIC, Australia
| | - Louisa J Remedios
- Physiotherapy, 2281The University of Melbourne, Carlton, VIC, Australia
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Bernhardt J, Lipson-Smith R, Davis A, White M, Zeeman H, Pitt N, Shannon M, Crotty M, Churilov L, Elf M. Why hospital design matters: A narrative review of built environments research relevant to stroke care. Int J Stroke 2021; 17:370-377. [PMID: 34427477 PMCID: PMC8969212 DOI: 10.1177/17474930211042485] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review, we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports healthcare in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behavior. Contrary to many new ward design approaches, single-bed rooms are neither uniformly favored, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing, and we highlight emerging collaborative multistakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.
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Affiliation(s)
- Julie Bernhardt
- Stroke, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Ruby Lipson-Smith
- Stroke, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Aaron Davis
- Stroke, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Marcus White
- Centre for Design Innovation, Swinburne University of Technology, Hawthorne, Australia
| | - Heidi Zeeman
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Natalie Pitt
- Silver Thomas Hanley (STH) Health Architecture, Australia
| | - Michelle Shannon
- Stroke, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Marie Elf
- School of Education, Health and Social Studies, University of Dalarna, Falun, Sweden
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Nordin S, Swall A, Anåker A, von Koch L, Elf M. Does the physical environment matter? - A qualitative study of healthcare professionals' experiences of newly built stroke units. Int J Qual Stud Health Well-being 2021; 16:1917880. [PMID: 34240677 PMCID: PMC8274537 DOI: 10.1080/17482631.2021.1917880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose: Organized care in specialist stroke units is fundamental for achieving better outcomes for persons with stroke. Although the importance of the physical environment for health and well-being is well recognized, research regarding how environmental features can influence stroke care is limited. The aim was to elucidate healthcare professionals’ experiences of the physical environment in newly built stroke units with respect to stroke care.Methods: Healthcare professionals (n = 42) representing eight professions participated in semi-structured, face-to-face interviews. Qualitative content analysis was used.Results: The physical environment both facilitated and restricted the professionals’ ability to provide stroke care. Five categories were identified: “Working towards patient engagement in single rooms”, “Hampered rehabilitation in an environment not always adapted to patients’ difficulties”, “Addressing patients’ psychosocial needs in the environment”, “Ensuring patient safety by using the environment in accordance with individual needs”, and “Collaboration and task fulfilment—a challenge due to care unit design”.Conclusions: The healthcare professionals viewed the physical environment mainly in relation to stroke patients’ specific needs, and several environmental features were considered poorly adapted to meet these needs. The physical environment is essential to high-quality care; thus, the process of planning and designing stroke units should be based on existing evidence.
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Affiliation(s)
- Susanna Nordin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Anna Swall
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Anna Anåker
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marie Elf
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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13
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Rosbergen ICM, Tonello I, Clark RA, Grimley RS. Does hospital design impact on patient activity levels and time spent alone? Disabil Rehabil 2020; 44:3173-3180. [PMID: 33336598 DOI: 10.1080/09638288.2020.1861117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to quantify changes in patients' activity levels, location and people present, within one acute stroke unit (ASU) and one inpatient rehabilitation unit (IRU) with respect to change in hospital design. METHODS A prospective observational study using behavioural mapping. We observed participants from 8 am till 5 pm every 10 minutes across two days and compared participant activity (physical, social and cognitive), location and people present pre and post-transition to new units. Built design, staffing levels and models of care were contrasted. RESULTS We recruited 73 participants (63% stroke): old-ASU (n = 19); new-ASU (n = 15); old-IRU (n = 19); new-IRU (n = 20). Compared to old, new units had more single rooms, larger floor spaces and higher staffing levels. We found no significant change in participants' activity levels between the old and new ASU. Participants in the new IRU showed increased physical activity (43.4% vs. 54.4%, p = 0.02) but social and cognitive activity remained similar. Participants were more alone (ASU 47.4% vs. 66.7%, p = 0.01; IRU 41.7% vs. 58.3%, p < 0.001), and less often with nursing staff (ASU 17.7% vs. 6.7%, p = 0.04; IRU 18.8% vs. 5.7%, p < 0.001) in new units. CONCLUSION Hospital design appears to impact on patients' physical activity. Single rooms may increase isolation and reduce interaction with nursing staff.Implications for rehabilitationDesign of new rehabilitation units needs to consider patients' social engagement with family, friends, other patients and staff in addition to privacy and infection control.A change in built design of rehabilitation units should prompt observation of patients' activity levels and engagement with people and available space to ensure optimal use of new environments.Promotion of communal spaces and activities away from the bedroom to encourage social engagement is recommended for patients recovering in rehabilitation facilities.Less time in contact with nursing staff in rehabilitation environments with predominantly single rooms suggests a review of clinical practice and patient safety is warranted.
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Affiliation(s)
- I C M Rosbergen
- Allied Health Services, Sunshine Coast Hospital and Health Services, Birtinya, Australia.,Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - I Tonello
- Allied Health Services, Sunshine Coast Hospital and Health Services, Birtinya, Australia
| | - R A Clark
- School of Health and Sports Science, University of the Sunshine Coast, Sippy Downs, Australia
| | - R S Grimley
- Medical Service Division, Sunshine Coast Hospital and Health Services, Birtinya, Australia.,Sunshine Coast Clinical School, School of Medicine, Griffith University, Birtinya, Australia
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Anåker A, von Koch L, Eriksson G, Sjöstrand C, Elf M. The physical environment and multi-professional teamwork in three newly built stroke units. Disabil Rehabil 2020; 44:1098-1106. [PMID: 32683998 DOI: 10.1080/09638288.2020.1793008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To explore multi-professional teamwork in relation to the physical environment in three newly built or renovated stroke units. MATERIALS AND METHODS An observational study was undertaken. The participants were all staff members of a multi-professional team working in the reviewed stroke units. The data were collected using behavioural mapping and semi-structured observations, and they were analysed by content analysis and descriptive statistics. RESULTS Out of all the observations in the behavioural mapping, very few were of two or more members from the team together with a patient. None of the included stroke units had a co-location for all the members of the multi-professional team. Three main categories emerged from the analysis of the interviews: (i) the hub of the unit; (ii) the division of places; and (iii) power imbalance. All the categories reflected the teamwork in relation to parts of the physical environment. CONCLUSION The design of the physical environment is important for multi-professional teamwork. Emphasis must be placed on better understanding the impact of the physical environment and on incorporating the evidence related to multi-professional teamwork during the design of stroke units.IMPLICATIONS FOR REHABILITATIONUnderstanding the link between the physical environment and effective teamwork can lead to more tailored and supportive design solutions.The design of the physical environment should be considered as a vital part of effective teamwork in stroke units.The physical environment should include shared workstations, allowing team members to meet and communicate face to face.
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Affiliation(s)
- Anna Anåker
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurovascular Diseases, Theme Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Christina Sjöstrand
- Department of Neurovascular Diseases, Theme Neuro, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marie Elf
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Architecture and Civil Engineering, School of Architecture, Chalmers University of Technology, Gothenburg, Sweden
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15
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Wang X, Wu C. An Observational Study of Park Attributes and Physical Activity in Neighborhood Parks of Shanghai, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2080. [PMID: 32245096 PMCID: PMC7143081 DOI: 10.3390/ijerph17062080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/20/2022]
Abstract
Evidence shows that neighborhood parks provide opportunities for urban residents to participate in physical activity, but little is known about the space-behavior relationship of physical settings. This study explored the patterns of use in neighborhood parks, and focused particularly on visitors' levels of activity supported by the specific landscape features and attributes. Behavior mapping data, including the users' characteristics, their behaviors and activity levels, and the landscape characteristics, were obtained in three neighborhood parks of Shanghai, China. A total of 6126 park users were documented during the observations, and most of them were involved in sedentary activity. This study found that different environmental settings such as water, plaza, lawn, and architecture supported different types and levels of activity. Although more men than women visited the neighborhood parks, women were more active than men in park-based physical activity. In this Chinese sample, the findings demonstrate behavior mapping is a promising tool to measure park-based physical activity. As this study associated the levels of use with the landscape features, the results are expected to be useful in design practice for promoting regular physical activity.
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Affiliation(s)
- Xinxin Wang
- Department of Landscape Architecture, College of Horticulture, Post-doctoral Research Station in Public Administration, Nanjing Agricultural University, Nanjing 210095, China
| | - Chengzhao Wu
- Department of Landscape Studies, Key Lab of Ecology and Energy Saving in High-density Human Settlements, College of Architecture and Urban Planning, Tongji University, Shanghai 200092, China;
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16
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Lipson-Smith R, Zeeman H, Bernhardt J. What's in a Building? A Descriptive Survey of Adult Inpatient Rehabilitation Facility Buildings in Victoria, Australia. Arch Rehabil Res Clin Transl 2020; 2:100040. [PMID: 33543069 PMCID: PMC7853350 DOI: 10.1016/j.arrct.2020.100040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To identify all the services that offer inpatient rehabilitation in Victoria, Australia, and to describe the buildings in which these services are housed, including their size, age, whether or not they were purpose-built, whether or not they are colocated with a tertiary hospital, the proportion of single-bed rooms, and ward layout. DESIGN Cross-sectional survey of inpatient rehabilitation buildings. Data were collected via telephone questionnaire and websites. PARTICIPANTS Sixty-four rehabilitation facilities were identified and all participated in the survey (37 public, 27 private). RESULTS Results revealed heterogeneity on most variables measured, including size (number of beds ranged from 2-104), age (oldest building built in 1860, and 26% built since 2010), purpose-built status (48% purpose-built), freestanding status (34% freestanding), percentage of single-bed rooms (ranged from 0%-100%), and layout. All facilities had a therapy gym, and most had a communal area (96%). CONCLUSION Since 2010, the proportion of buildings being purpose-built and colocated with a tertiary hospital has increased. The proportion of single-bed rooms has also increased and is especially high in privately funded facilities. Results suggest that rehabilitation design is influenced by norms and evidence from acute medical health care despite the purpose of care being different: acute care (short-term, medical illness) and rehabilitation (longer-term, recovery, relearning).
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Affiliation(s)
- Ruby Lipson-Smith
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria
| | - Heidi Zeeman
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland
- The Hopkins Centre Research for Rehabilitation and Resilience, Brisbane, Queensland
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria
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McRae P, Bew P, Smith S, Mudge A. An observational study of physical, cognitive and social activities in rehabilitation inpatients. Australas J Ageing 2020; 39:217-224. [PMID: 32096897 DOI: 10.1111/ajag.12785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/02/2020] [Accepted: 02/06/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe patient behaviour related to mobility in a rehabilitation inpatient setting and compare intensive and Transition Care Program (TCP, slow-stream rehabilitation) models. METHODS Prospective cross-sectional design including weekday and weekend sampling in two rehabilitation wards (one intensive and one TCP) in a publicly funded facility. A single trained observer undertook behavioural mapping, observing patient location, mobility, activity and company on all inpatients 8 am-4 pm using a structured 2-minute observation protocol. Observations were summarised and compared between wards. RESULTS We observed 74 inpatients on a Tuesday and 77 on a Sunday. Participants spent 7% (median) of daytime standing or walking. They spent 62%-87% in their room, 22%-40% sleeping or resting and 74%-86% alone. The only significant difference between wards was time spent off ward on Tuesday. Activity was lower on Sunday. CONCLUSIONS Time spent in physical, cognitive and social activities is low in inpatient rehabilitation and TCP wards.
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Affiliation(s)
- Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - Paul Bew
- Brighton Health Campus, Brisbane, Qld, Australia
| | - Simon Smith
- Institute for Social Science Research, The University of Queensland, Brisbane, Qld, Australia
| | - Alison Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
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18
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Arbel I, Ye B, Mihailidis A. Stroke Patients' Experiences in an Adaptive Healing Room in a Stroke Rehabilitation Unit. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 13:170-185. [PMID: 31631699 DOI: 10.1177/1937586719879060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study evaluated the user experiences (UX) of stroke patients residing in the adaptive healing room (AHR) and compared them to the UX of patients residing in standard private rooms (SPRs). BACKGROUND Healing environments in healthcare settings can promote patients' healing processes, outcomes, and psychological well-being. The AHR was designed as a healing environment for stroke patients and has been previously evaluated in laboratory settings. This study was the first to evaluate it in its intended context-a stroke rehabilitation unit. METHODS The UX of 10 patients residing in the AHR and 15 patients residing in SPRs were collected via structured interviews with a set of open-ended questions and analyzed using quantitative and qualitative methods. RESULTS The AHR design features (orientation screen, skylight, and nature view) were rated positively by most patients. The skylight emerged as the least favorable. Responses to open-ended questions revealed that UX may be further improved if patients have more control over some of the settings (e.g., light intensity and nature views), and if the system allowed for more stimulation for patients at later stages of their recovery. Additionally, the results suggest that patients in the AHR have better UX than patients in the SPRs. CONCLUSION The AHR has the potential to improve UX in the stroke rehabilitation unit. Patient feedback can be used to refine the AHR before carrying out clinical trials to assess the effect of the AHR on patient outcomes (e.g., sleep, mood, and length of stay) and stroke recovery.
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Affiliation(s)
- Ifah Arbel
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Bing Ye
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alex Mihailidis
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Lipson-Smith R, Churilov L, Newton C, Zeeman H, Bernhardt J. A Framework for Designing Inpatient Stroke Rehabilitation Facilities: A New Approach Using Interdisciplinary Value-Focused Thinking. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 12:142-158. [PMID: 30799632 PMCID: PMC6745610 DOI: 10.1177/1937586719831450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aim: To use Value-Focused Thinking to investigate what is important in the design
of inpatient stroke rehabilitation facility buildings. Background: Many stroke patients require inpatient rehabilitation in a dedicated
facility. Rehabilitation facilities are healthcare spaces, but they are also
learning spaces where patients practice targeted tasks to acquire new skills
and to reacquire skills and abilities that were compromised as a result of
their stroke. There is currently no consensus regarding how the design of
inpatient rehabilitation facilities could be optimized for patients’
learning. Method: We used Value-Focused Thinking to develop a framework of what
interdisciplinary experts consider important for inpatient stroke
rehabilitation facility design. Two workshops were conducted. The following
experts were invited to participate: past patients with experience of stroke
rehabilitation; stroke rehabilitation clinicians; stroke rehabilitation
academics; healthcare environments academics; learning environments
academics; architects, designers, and wayfinders with experience designing
healthcare or learning environments; and healthcare design policy
makers. Results: Thirty experts participated. The experts’ final framework included 16
criteria that were considered fundamentally important for inpatient stroke
rehabilitation facility design, and 14 criteria that were considered
instrumentally important. Inpatient stroke rehabilitation facility design
should maximize efficiency, maximize effectiveness (i.e., patients’ clinical
and functional outcomes), foster emotional well-being, and maximize safety.
Opportunities to practice physical, cognitive, and social activity were
considered important for patients’ outcomes. Conclusions: Value-Focused Thinking was an effective and equitable means of engaging
experts from multiple disciplines. Designers, planners, and developers of
inpatient stroke rehabilitation facilities should consider the
rehabilitation-specific framework developed in this study alongside evidence
from other healthcare settings.
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Affiliation(s)
- Ruby Lipson-Smith
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Clare Newton
- Faculty of Architecture, Building and Planning, University of Melbourne, Melbourne, Victoria, Australia
| | - Heidi Zeeman
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,The Hopkins Centre Research for Rehabilitation and Resilience, Brisbane, Queensland, Australia
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria, Australia
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Scrivener K, Pocovi N, Jones T, Dean B, Gallagher S, Henrisson W, Thorburn M, Dean C. Observations of Activity Levels in a Purpose-Built, Inpatient, Rehabilitation Facility. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 12:26-38. [DOI: 10.1177/1937586718823519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Effective rehabilitation should include high levels of physical activity. The impact of the environmental design on activity levels has had minimal consideration. Purpose: This study investigates activity levels of inpatients undergoing rehabilitation in a new rehabilitation facility with innovative design and multidisciplinary care, comparing weekday and weekend activity levels, as well as changes over a 12-month period. Method: An observational study reporting participants’ location, people present, body position, and activity type on 2 weekdays and 1 weekend day using behavior mapping techniques. Fifteen participants were observed in a mixed rehabilitation unit with neurological, orthopedic, and other health conditions. Results: Results were calculated as the proportion of observations participants spent in each location, position, and performing activities (physical, cognitive, social), and time spent alone and inactive. On average, participants were engaged in activity for 86% (standard deviation [ SD] = 9) of the day, with physical activity accounting for 51% ( SD = 11), cognitive activity 28% ( SD = 10), and social activity 42% ( SD = 16). There was more physical activity (mean difference [ MD] 8% absolute, confidence interval [CI] = [4, 12], p < .01) and less social activity ( MD −6% absolute, CI [−11, −1], p = .02) on weekdays compared to weekends. Overall, participants were alone and inactive for 12% ( SD = 9) of the day. Participants observed in 2016 displayed similar results to those observed in 2015. Conclusion: High levels of activity were achieved in this facility that underwent environmental redesign, construction of new facilities, and implementation of evidence-based strategies.
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Affiliation(s)
- Katharine Scrivener
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Natasha Pocovi
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Taryn Jones
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Bridget Dean
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Shaun Gallagher
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Wesley Henrisson
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Michael Thorburn
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Catherine Dean
- Department of Health Professions, Macquarie University, New South Wales, Australia
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Rosbergen IC, Grimley RS, Hayward KS, Brauer SG. The impact of environmental enrichment in an acute stroke unit on how and when patients undertake activities. Clin Rehabil 2018; 33:784-795. [PMID: 30582368 DOI: 10.1177/0269215518820087] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES: To explore the effect of environmental enrichment within an acute stroke unit on how and when patients undertake activities, and the amount of staff assistance provided, compared with a control environment (no enrichment). DESIGN: This is a substudy of a controlled before-after observational study. SETTING: The study was conducted in an Australian acute stroke unit. PARTICIPANTS: The study included stroke patients admitted to (1) control and (2) environmental enrichment period. INTERVENTION: The control group received standard therapy and nursing care, which was delivered one-on-one in the participants' bedroom or a communal gym. The enriched group received stimulating resources and communal areas for mealtimes, socializing and group activities. Furthermore, participants and families were encouraged to increase patient activity outside therapy hours. MAIN MEASURES: Behavioral mapping was performed every 10 minutes between 7.30 a.m. and 7.30 p.m. on weekdays and weekends to estimate activity levels. We compared activity levels during specified time periods, nature of activities observed and amount of staff assistance provided during patient activities across both groups. RESULTS: Higher activity levels in the enriched group ( n = 30, mean age 76.7 ± 12.1) occurred during periods of scheduled communal activity ( P < 0.001), weekday non-scheduled activity ( P = 0.007) and weekends ( P = 0.018) when compared to the control group ( n = 30, mean age 76.0 ± 12.8), but no differences were observed on weekdays after 5 p.m. ( P = 0.324). The enriched group spent more time on upper limb ( P < 0.001), communal socializing ( P < 0.001), listening ( P = 0.007) and iPad activities ( P = 0.002). No difference in total staff assistance during activities was observed ( P = 0.055). CONCLUSION: Communal activities and environmental resources were important contributors to greater activity within the enriched acute stroke unit.
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Affiliation(s)
- Ingrid Cm Rosbergen
- 1 Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.,2 Allied Health Medical Services, Neurosciences, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Rohan S Grimley
- 3 Sunshine Coast Clinical School, The University of Queensland, Birtinya, QLD, Australia
| | - Kathryn S Hayward
- 1 Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.,4 Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada.,5 AVERT Early Rehabilitation Research Group, Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.,6 NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, VIC, Australia
| | - Sandra G Brauer
- 1 Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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