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L11 Exercise and fitness training
after stroke
Service implementation and evaluation:how it works in practice
Dr. Catherine Best, Dr. Frederike van Wijck, John Dennis, Dr Susie Dinan-Young & Rebecca Townley
Content
1. Introduction
2. EAS Services : a survey
3. 2010 Guidelines for best practice
4. Professional requirements
5. EAS Service Model
6. Summary
1. Introduction – what ?
Evidence of the need for Exercise and fitness training
after stroke (EAS) services
- Research: exercise can be beneficial after stroke
- Royal College of Physicians: recommendations for exercise after stroke
- English & Scottish Government: policy documents on exercise after stroke
- Many medical & AHP refer stroke patients for exercise
- Many people after stroke self refer for exercise….
1. Introduction – who ?EAS service professionals & stakeholders
- National : the Public Health Depts of the 4 countries- The Regional Health Authorities- PCTs/GP Consortia/Community Health Partnerships etc- Commissioners- Stroke Management Clinical Networks (Stroke MCN)- Stroke secondary & primary medical & AHP professionals ( refers) &
researchers (evaluation)- ER Co-ordinators & exercise professionals- Stroke participants/patients
- ….
1.Introduction-Where? What? How?
EAS services : some questions
• Where do people with stroke go for exercise?
• What kind of exercise services are available?
• How do they run?
• What do they provide?
• How do we know if they are effective? Safe?
• How do we know if the exercise professionals are qualified?
Many questions – but no satisfactory answers, until…
Content1. Introduction
2. EAS Services : a survey
3. 2010 Guidelines for best practice
4. Professional requirements
5. EAS Service Model
6. Summary
2. EAS services in Scotland: a survey
Scotland-wide scoping exercise:Aims: • To identify content and structure of EAS
services in Scotland• To identify and disseminate best practice
Methods:• Internet survey• Interviews with selected services( 2010 Best, Mead, van Wijck, Smith, Dennis, Dinan-Young, Fraser, Donaghy)
2. EAS services in Scotland: a survey
Results : ( findings)
1. 14 stroke-specific with an aerobic component:
Rehabilitation extensions; to aid transition to community exercise (3)
Leisure centre services ; to encourage PA in community (3)
Charity collaborations; respond to members requests (8)
2. Significant variation in content, FITT, qualifications, training and experience, referral criteria and process
Led ByRehab Setting:
PT/stroke nurses with assistants
Leisure Setting: EP’s in collaboration
with PT
Charity Collaborations:EP’s, Personal Trainers
PT
Referral HCP HCP none
Inc/ Excl medical criteria variable none
Evaluation Standard outcomemeasures
varies; may include BP,physical
performance, activity Q
none
Duration 8-10 weeks ongoing ongoing
Cost Free approx. £3 per session £0 - £2
Staff ratio 1 to 7 1 to 5 1 to 10
Other exercise and physical activity options • ARNI Trust: Functional training after stroke (L4 CPD & AHP)
• + NON stroke specific– ***Mutipathology exercise classes**– Cardiac rehabilitation– Disability swimming groups and disability sports groups– Generic exercise referral schemes– Extend, class diamonds (exercise for older people)– Personal trainers
• Without aerobic evidence for stroke – Chair-based exercise in stroke charity support group
meetings– Pilates, yoga, tai chi etc.
Content1. Introduction
2. EAS Services: a survey.
3. 2010 Guidelines for best practice
4. EAS Service model
5. Professional requirements
6. Summary
3. EAS: Guidelines for Best Practice
Key guidelines for EAS service providers:• Governance• Preparation and risk assessment for exercise• Referral systems and procedures• Pre-exercise assessment and ongoing review• Specialist Exercise Professional training• Content, frequency and duration • Record keeping
3. EAS: Guidelines for best practice
Other good practice points:• EP to make personal contact before 1st session• Carer/ volunteer to accompany client to 1st
session• EAS service to:
– Provide transport as appropriate– Arrange in-service staff ‘stroke awareness’ training– Refer back for Orthotics etc assessment if required– Invite trainee EPs/ HCPs (does not affect staff: client ratio)
3. EAS: Guidelines for best practice
Available to download from:
http://exerciseafterstroke.org.uk/
All UK Stroke MCNs and Cardiovascular Networks, the Stroke NGOs and the CSP,ACPIN, Skills Active & REPS were emailed direct with
these guidelines in November 2010
Content1. Introduction
2. EAS Services: a survey.
3. 2010 Guidelines for best practice
4. Professional requirements
5. EAS Service model
6. Summary
4. EAS : Professional requirements
Whatever the country ( England, Scotland, Wales, Ireland ) & type of Ex Referral service model, there are a number of ethical and professional standards that all Exercise Professionals must adhere to when working with all patient populations.
•See Section 8.10 in course syllabus
4. EAS : Professional requirements
3. National Skills Active Physical Activity Standards for People after Stroke (Unit D561):
• Design and agree a physical activity programme with people after stroke
• Deliver, review, adapt and tailor a physical activity programme with people after stroke
This Exercise after Stroke course is based on these
National Occupational Stroke Instructor Standards
Content1. Introduction
2. EfS Services: a survey.
3. 2010 Guidelines for best practice
4. Professional requirements
5. EAS Service Model
6. Summary
5. EAS: Referral Process
• See page 18 Fig.2 of Best Practice Guidance for the Development of Exercise after Stroke Services in Community Settings
5. EAS: Service Model Management
• See page 13 Fig.1 of Best Practice Guidance for the Development of Exercise after Stroke Services in Community Settings
5. EAS: Local Service Model
Content
1. Introduction
2. EAS Services: a survey.
3. 2010 Guidelines for best practice
4. Professional requirements
5. EAS Service Model
6. Summary
5. EAS Service Implementation: Summary
• EAS is a relatively new and fast developing area
• Three different service models UK wide
• Suggested guidelines for best practice for EAS services (incl. methods for service evaluation)
• Single professional, ethical and medico-legal standards for EAS ExP – wherever the patient lives!
Essential ReadingFurther detail about the topics discussed in this
session can be found in section L8 of the
course syllabus.