Article

OBJECTIVES: To determine whether an enriched environment embedded in an acute
stroke unit could increase activity levels in acute stroke patients and reduce
adverse events. DESIGN: Controlled before-after pilot study. SETTING: An acute
stroke unit in a regional Australian hospital. PARTICIPANTS: Acute stroke
patients admitted during (a) initial usual care control period, (b) an enriched
environment period and (c)
a sustainability period. INTERVENTION: Usual care
participants received usual one-on-one allied health intervention and nursing
care. The enriched environment participants were provided stimulating resources,
communal areas for eating and socializing and daily group activities. Change
management strategies were used to implement an enriched environment within
existing staffing levels.
MAIN MEASURES: Behavioural mapping was used to estimate
patient activity levels across groups. Participants were observed every 10
minutes between 7.30 am and 7.30 pm within the first 10 days after stroke.
Adverse and serious adverse events were recorded using a clinical registry.
RESULTS: The enriched environment group ( n = 30, mean age 76.7 +/- 12.1) spent a
significantly higher proportion of their day engaged in 'any' activity (71% vs.
58%, P = 0.005) compared to the usual care group ( n = 30, mean age 76.0 +/-
12.8). They were more active in physical (33% vs. 22%, P < 0.001), social (40%
vs. 29%, P = 0.007) and cognitive domains (59% vs. 45%, P = 0.002) and changes
were sustained six months post implementation. The enriched group experienced
significantly fewer adverse events (0.4 +/- 0.7 vs.1.3 +/- 1.6, P = 0.001), with
no differences found in serious adverse events (0.5 +/- 1.6 vs.1.0 +/- 2.0, P = 0.309). CONCLUSIONS: Embedding an enriched environment in an acute stroke unit
increased activity in stroke patients.

Langue : ANGLAIS