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Home-based rehabilitation for severe stroke

A home-based rehabilitation intervention for survivors of stroke with severe disability (HoRSSe study) 

Why the research is needed? 

Many survivors of stroke are left with disabilities and for some these can be very debilitating. Whilst much consideration has been given to the needs of less impaired survivors, there has been a lack of research in terms of how to treat those with more complex needs. 

What is already known about the subject? 

There is strong research evidence to show that stroke survivors with mild to moderate disability benefit from receiving specialist stroke rehabilitation at home. Our previous research has informed how multidisciplinary teams of therapists and nurses should be set up to deliver these services in practice. What is needed is more research to understand what would be the best rehabilitation treatment for stroke survivors with more complex needs and how these services could provide this. 

Who we are working with? 

We are working with a team in Nottingham, to whom survivors with complex needs are referred and who would like to improve the service they provide. 

How are patients and the public involved? 

We have discussed the provision of care for stroke survivors in their own home with our Nottingham stroke partnership group. The group’s comments have informed our study proposal and we will work in partnership with them as the study progresses. The proposal is also based on patient participation in a previous study in which what matters most to stroke survivors with complex needs and their families was investigated. 

What we will do? 

We will conduct a study with 3 work packages:

Work package 1 will involve reaching an agreement on what would be the best rehabilitation treatment working with clinical colleagues and researchers. This will include a secondary consideration to determine what treatments are recommended in light of the current COVID-19 situation.

Work package 2 will involve working with the Nottingham team to support them in delivering the treatment.

Work package 3 will involve collection of data to understand how the treatment was delivered and what impact it had. This will include how much and how quickly rehabilitation was provided to stroke survivors and also what strain was experienced by family member’s caring for them. We are also interested in how health and social care services work together to care for the stroke survivor. 

What the benefits will be? 

This research will provide much needed guidance about the type of care that is required for approximately 20% of all stroke survivors who leave hospital with severe disability. This will address current inequalities in provision of community stroke care in the country. 

When the findings will be available? 

The study starts on 1 April 2020 and the initial findings will be in April 2021 with final report in April 2023. 

How we are planning for implementation? 

We are working with local clinicians and commissioners (who make decisions about what services are provided). We are also working nationally with NHS England to influence what changes can be made to stroke care across the country. 

Contact

Dr Rebecca Fisher, Rebecca.fisher@nottingham.ac.uk