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Research and Projects

ReTrain

Who is involved?

Theme: Person-Centred Care
Status: Live

Read a BITE sized summary of this project (PDF)

Background

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 impact strokes have on the patient, their family and carers, offering continuing support needs to be a priority.

Method

The ReTrain (Rehabilitation Training) project was designed following a question raised by a stroke survivor taking part in the PenCLAHRC question generation process. Since then, a group of stroke survivors and their partners have advised us on a range of developmental projects over a period of four years. This work has resulted in us being successful in winning research funding from the Stroke Association charity to carry out a pilot randomised controlled trial to test whether the ReTrain programme can help support stroke survivors in their ongoing recovery after discharge from NHS rehabilitation services.

The Retrain programme is a combination of expert guidelines together with key elements of an approach called ARNI (Action for Rehabilitation of Neurological Injury).

Through conducting the ReTrain pilot trial, we will also be able to see whether it is feasible to design and carry out a larger trial which would be a fair test of whether ReTrain can improve the lives of stroke survivors. The overall aim of our programme of research is to find out whether ReTrain can help stroke survivors to improve their recovery (particularly their physical mobility) after a stroke. If so, this will enable organisations providing stroke support services to decide whether to offer ReTrain programmes. It will also help stroke survivors decide whether they want to take part in the programme.

For more information about the trial, please contact Dr Raff Calitri

Preliminary work

We were able to design this pilot trial after completing a range of development work.

We conducted a range of development studies to build a case for a clinical trial of ARNI. These included:

  • A case series, in which six long-term stroke survivors were provided with one-to-one ARNI-based training by an Exercise Professional. This work was published and the paper can be found here.
  • A second case study in which ten stroke survivors  received training on a specific ARNI strategy for getting up from the floor without help or aids. The study was partially funded by the Royal Devon and Exeter Hospital Trust and the work has been presented as a poster at the UK Stroke Forum in 2013 and the UK Stroke Assembly in 2014. View the poster here.
  • Investigating the rationale for providing and intervention like ARNI, including a review of current guidelines on exercise-based rehabilitation after stroke. 
  • A qualitative study exploring long-term stroke survivors' motivations for taking up and continuing with an exercise programme. 
  • A methodological study investigating how to judge whether an exercise-based rehabilitation programme has been delivered true to the way in which it was designed.

For further information about this development work please contact Dr Sarah Dean.

Current activity

The ReTrain project is nearly complete. We recruited 50 volunteers who were randomly assigned to either the ReTrain programme or the control group. The training programmes are complete and we have just collected all of our follow-up outcome measurements. We are entering our data analysis stage and expect to report results of the pilot trial early 2017.

Further information

The ReTrain protocol paper has been accepted for publication and is now publicly available from BMJ Open.

The ReTrain team have been awarded the Patient, Carer and Public Involvement (PCPI) 2016 Prize recognising our excellent approach to public engagement throughout the course of this research. This award will be presented to Prof Dean at the forthcoming prestigious UK Stroke Forum conference in November 2016.

To find out more about the project's successes, please read our news article.

Related publications

Poltawski L, Briggs J, Forster A, Goodwin VA, James M, Taylor RS, Dean S. Informing the design of a randomised controlled trial of an exercise-based programme for long term stroke survivors: Lessons from a before-and-after case series study. BMC Research Notes 2013, 6:324

Poltawski L, Abraham C, Forster A, Goodwin VA, Kilbride C, Taylor RS, Dean S. Synthesising practice guidelines for the development of community-based exercise programmes after stroke. Implementation Science 2013, 8:115

Poltawski, L, Boddy, K, Forster, A, Goodwin, V, Pavey, AC, Dean S (2014) Motivators for uptake and maintenance of exercise: perceptions of long-term stroke survivors and implications for design of exercise programmes. Disability and Rehabilitation.

Others Involved

Dr Leon Poltawski, Professor Anne Forster, Professor Rod Taylor, Professor Anne Spencer, Dr Martin James, Rhoda Allison, Shirley Stevens, Dr Meriel Norris, Professor John Campbell, Professor Charles Abraham, Professor Christina Victor, Professor Melvyn Hillsdon, Jacqueline Briggs, Dr Vicki Goodwin, Professor William Henley, Anthony Shepherd, Laura Hollands, Dr Richard Pulsford

Partners

PenCLAHRC PPI Group – Stroke Survivors and their carers
South West Stroke Research Network
Stroke Association


Downloads

  • Case study example of the value of NIHR CLAHRC funding - PDF