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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 three teams across the country 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 the core components of home-based rehabilitation for survivors of stroke with severe disability. This will be achieved by bringing together clinicians, researchers and those with lived experience to form expert panels. 

Work package 2 will involve working with three teams across the country to explore the challenges and positive influences (facilitators) faced by clinicians in providing the agreed components from work package 1, in NHS practice. 

Work package 3 will use routinely collected audit data to explore the trends in patients discharged from hospital, focusing upon rate and complexity over a 3-year time period. This helps provide an understanding of demand on community services in order to inform commissioning.

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 December 2021 with final report in April 2024.

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. 


Lal Russell,, or Frankie Riley-Bennett,