Faculty of Health, Social Care and Education, Kingston University & St George's, University of London, London, UK.
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Int J Stroke. 2021 Aug;16(6):669-682. doi: 10.1177/1747493020969367. Epub 2020 Nov 2.
Stroke patients are often inactive outside of structured therapy sessions - an enduring international challenge despite large scale organizational changes, national guidelines and performance targets. We examined whether experienced-based co-design (EBCD) - an improvement methodology - could address inactivity in stroke units.
To evaluate the feasibility and impact of patients, carers, and staff co-designing and implementing improvements to increase supervised and independent therapeutic patient activity in stroke units and to compare use of full and accelerated EBCD cycles.
Mixed-methods case comparison in four stroke units in England.
Interviews were held with 156 patients, staff, and carers in total; ethnographic observations for 364 hours, behavioral mapping of 68 patients, and self-report surveys from 179 patients, pre- and post-implementation of EBCD improvement cycles.Three priority areas emerged: (1) 'Space' (environment); (2) 'Activity opportunities' and (3) 'Communication'. More than 40 improvements were co-designed and implemented to address these priorities across participating units. Post-implementation interview and ethnographic observational data confirmed use of new social spaces and increased activity opportunities. However, staff interactions remained largely task-driven with limited focus on enabling patient activity. Behavioral mapping indicated some increases in social, cognitive, and physical activity post-implementation, but was variable across sites. Survey responses rates were low at 12-38% and inconclusive.
It was feasible to implement EBCD in stroke units. This resulted in multiple improvements in stroke unit environments and increased activity opportunities but minimal change in recorded activity levels. There was no discernible difference in experience or outcome between full and accelerated EBCD; this methodology could be used across hospital stroke units to assist staff and other stakeholders to co-design and implement improvement plans.
尽管进行了大规模的组织变革、制定了国家指南和绩效目标，但中风患者在结构化治疗疗程之外往往缺乏活动——这是一个持久的国际挑战。我们研究了以经验为基础的共同设计（EBCD）——一种改进方法——是否可以解决中风病房的不活动问题。
评估患者、护理人员和工作人员共同设计和实施改进方案以增加中风病房中接受监督和独立治疗的患者活动量的可行性和影响，并比较使用完整和加速 EBCD 周期的情况。
在英格兰的四个中风病房中进行混合方法病例比较。
共对 156 名患者、工作人员和护理人员进行了访谈；进行了 364 小时的民族志观察、对 68 名患者进行了行为映射以及在实施 EBCD 改进周期前后对 179 名患者进行了自我报告调查。出现了三个优先领域：（1）“空间”（环境）；（2）“活动机会”和（3）“沟通”。在参与的病房中，共同设计和实施了 40 多项改进措施来解决这些优先事项。实施后的访谈和民族志观察数据证实，新的社交空间得到了利用，活动机会也有所增加。然而，工作人员的互动仍然主要是任务驱动的，对促进患者活动的关注有限。行为映射表明，实施后社会、认知和身体活动有所增加，但各站点的情况各不相同。调查的回复率很低，为 12-38%，结果不确定。
在中风病房中实施 EBCD 是可行的。这导致中风病房环境得到了多项改进，活动机会有所增加，但记录的活动水平变化不大。完整和加速 EBCD 的经验或结果没有明显差异；这种方法可以在整个医院中风病房中使用，以帮助工作人员和其他利益相关者共同设计和实施改进计划。
