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Evaluating the effectiveness and cost-effectiveness of a physical REhabilitation TRAINing programme for stroke survivors
Strokes are the third largest cause of death in the UK and approximately 110,000 people have a stroke each year in this country. The most common form, Ischaemic stroke, is caused by a blood clot narrowing or blocking the blood vessels so that blood cannot reach the brain, leading to brain damage. Strokes are the leading cause of disability in adults. Of the 900,000 in this country who have had a stroke, 300,000 live with moderate to severe disability.
Due to the long-term impacts strokes have on the patient, their family and carers, offering continuing support needs to be a priority. The ReTrain project is evaluating a programme concerned with improving the quality of life of long-term stroke survivors (those at least 6 months since stroke) by enhancing functionality, levels of activity and participation in everyday life, and the capacity to self-manage.
We are evaluating a programme called Action for Rehabilitation following Neurological Injury (ARNI), which teaches physical and mental exercises, techniques and strategies to help patients re-adjust and obtain autonomy in the community. The suggestion to evaluate ARNI was made by a stroke survivor taking part in the PenCLAHRC research question-generation process. Our work is assessing the potential of ARNI for commissioners, service providers and service users.
We have been conducting a range of development studies to build the case for a clinical trial of ARNI. These have included:
• a case series, in which six long term stroke survivors were provided with one-to-one ARNI-based training by an Exercise Professional
• a second case series, in which ten stroke survivors received training in a specific ARNI strategy for getting up from the floor without help or aids.
• investigating the rationale for providing an intervention like ARNI, including a synthesis of current guidelines on exercise-based rehabilitation after stroke
These and several other studies are being used to develop the case for funding of a full trial of the ARNI programme.