Rehabilitation Therapy Edinburgh
The Astley Ainslie Hospital provides rehabilitation services for adults with acquired brain injury, stroke, orthopaedic injuries, limb amputation, and progressive neurological disorders such as multiple sclerosis (MS). There is good evidence that rehabilitation can improve recovery from stroke 4 The recovery of specific functions such as walking and upper limb activities are improved through repetitive, task-specific practice with performance feedback 5 , all delivered, typically, by rehabilitation professionals.
In this feasibility study the intervention was delivered by a clinical psychologist; this delivery approach might not be possible in practice, however, because of the shortage of trained psychologists in stroke care, at least in the UK 26 Thus, when proposing this intervention we had decided that it would ultimately be delivered by stroke nurses.
Inclusion criteria: a) ≥18 years old, b) stroke 3-24 months previously, c) self-reported fatigue, and d) living in the Lothian area, Scotland, UK. Exclusion criteria: a) severe depression (assessed by the screening questionnaire PHQ-9 scored 15 or more), b) significant impairments in cognition or communication (as recorded in medical notes or assessed by responsible stroke physicians or general practitioners who had helped us identify potential participants), c) medically unstable or living in nursing home, or d) currently in other research studies or receiving any treatment for fatigue or depression, or would increase the physical burden of the participants.
From July 2014 to October 2014, we identified potential participants from patients who had been discharged from a stroke unit (Royal Infirmary of Edinburgh), patients who had visited an outpatient stroke clinic (Western General Hospital), and those who had been visited by nurses from a community stroke service (Chest Heart & Stroke Scotland, CHSS) in Lothian area, Scotland.
The initial one year scheme will extend the existing Edinburgh Leisure-based ‘exercise after stroke pathway' by bridging the gap from the hospital setting to leisure centres in the community, by ensuring the patient can enjoy continuing appropriate exercise in their road to improved health.
The second workshop provided recommendations for improving the adoption of technologies in stroke rehabilitation: an annual exhibition of commercially available and developing technologies, an online consumer-rating website of available technologies, and a user network to inspire and test new technologies.
Our aim was to identify stakeholder priorities for stroke rehabilitation technologies using an adapted version of the James Lind Alliance approach to priority setting Edninburgh 15 and then use these priorities to generate user-centered solutions to enhance the everyday adoption of technologies by users, therapists, patients, and caregivers.
Based on psychological correlates of PSF and evidence-based psychological interventions for fatigue in other medical conditions, we developed a manualised psychological intervention for PSF, with input from stroke clinicians, psychological therapists, and stroke survivors.
The observation that fatigue seemed to start at the time of the stroke, and that post-stroke fatigue was different in phenomenology than prestroke fatigue is consistent with the concept that the brain lesion itself might trigger fatigue 12 Thus, neuroimaging studies would be warranted to explore in more detail associations between fatigue and the site and size of the brain lesion.