Title: Feasibility of a breakfast group intervention for acute stroke units, to provide intensive eating and drinking interventions as well as integrated multi-disciplinary team working and personalized care.
Funder: Health Education England

Abstract: Research Question: Can a co-designed breakfast group intervention for acute stroke units provide intensive eating and drinking interventions supported by a multi-disciplinary skill sharing and an integrated actionable tool-kit? Background: There are 1.2 million stroke survivors in the UK with up to 84% of PwS experiencing problems that effect eating and/or drinking (2). Difficulties vary considerably, but commonly they disrupt the ability to consume adequate amounts food and/or drink and also take pleasure from the experience (2). The complexity of eating and drinking challenges are widely recognized in the literature (3)(4) resulting in malnutrition, dehydration, reduced muscle strength, pressure ulcers and low mood (5)(6)(7). Research emphasizes the negative impact on emotional well-being associated with dependency on others and lack of control (4). Therefore eating and drinking challenges can cause serious disruptions that impact on health, well-being and quality of life (6)(8). Aim: To co-design a breakfast group and supporting actionable tool-kit that increases the number of eating and drinking interventions on an acute stroke unit as well as improving processes and promoting an integrated approach to care. Objectives: Review research evidence and theories relevant to rehabilitation of eating and drinking problems to inform intervention planning and design. Co-design with stakeholder and advisory groups a breakfast group intervention and supporting actionable tool-kit. Iteratively test the acceptability and feasibility of the intervention and accompanying actionable tool-kit in three stroke units.Methods: A co-design approach will bringing patients, carers and healthcare professionals together in a design development process (9). Methods include semi-structured interviews, focus groups, ethnographic observations and co-design tools and techniques such process mapping and prototyping. Plan: The intervention will be tested in one stroke unit, iteratively developed refined and further tested in two additional units to establish the feasibility and acceptability for patients and health care professionals. Outcomes: Increasing the intensity of eating and drinking practice in a breakfast group intervention will improve patient outcomes by providing more opportunities to practice strategies with enabling support. Creating an actionable tool-kit for multi-disciplinary assessment, care planning, patient centered goal setting and outcome measurement will improve quality of care for people with eating and drinking challenges. Anticipated impacts and dissemination:Addressing eating and drinking challenges in early rehabilitation will enable people with stroke to cope with the rigours of rehabilitation and prevent complications that can arise from malnutrition and dehydration. Interventions that address the emotional challenges related to a change in eating and drinking habits are required to that in the long-term people living with the effects of stroke can feel better about themselves and enjoy the experience of social dinning. This study will provide an evidence-based intervention with a supporting high quality actionable tool-kit which will improve clinical outcomes, provide greater process consistency, increase intensity of interventions and ultimately improve the patient experience.The results of this study will be shared locally with patient and health care professionals and more widely at national and international conferences. It will be published in journals, through social media and through patient story videos.

Lay abstract: Current evidence shows that many people living with stroke experience major problems with eating and drinking. We know that this can lead to malnutrition, dehydration, reduced muscle strength and depression. It can also lead to longer stays in hospital, reduced ability to participate in rehabilitation and in the long-term poorer quality of life. People living with stroke say the pleasure gained from eating and drinking changes. They describe feeling embarrassed and ashamed and report a loss of self-confidence. Therefore, being able to eat and drink independently is essential for health and well-being. People with stroke welcome opportunities to address eating and drinking problems early in their rehabilitation and would like more opportunities to practice the necessary skills needed, to regain independence. Early rehabilitation interventions have the potential to improve long-term outcomes by providing strategies, assistive devices and rehabilitation as early as possible in stroke recovery. People with stroke seem to enjoy the social aspects of sharing a meal together and welcome the opportunity to practice their rehabilitation strategies in a more meaningful and purposeful way. Health care professionals are using breakfast groups to provide opportunities to practice preparation and consumption of food and drink with enabling support. They are delivering this in a variety of ways and unsure about which way is best. Consultations with patients and health care professionals have found that the processes involved in breakfast group interventions lack rigour and multi-disciplinary team co-ordination, thus leading to uncertainty about what outcomes are achieved for each patient. This study aims to find out if it is possible to improve patient outcomes by providing more intensive interventions in a breakfast group format delivered by a range of health care professionals, who are sharing skills and working collaboratively supported by an integrated approach to assessment, care planning and measuring outcomes. This research question and study design have been shaped by patients, stroke researchers and health care professionals. They will also be involved throughout the study as this research will be co-produced and co-designed by a stakeholder and advisory groups, comprising of expert researchers, patients, public, carers and stroke unit health care professionals. This study will be conducted in three stages: The relevant theories and evidence will be examined to ensure that the intervention is based on best evidence and knowledge. An intervention and supporting tool-kit will be co-designed and tested in one stroke service. The intervention and tool-kit will then be reviewed, improved and tested in two additional stroke units. The proposed intervention will last approximately one hour and be delivered over five days of the week. It will include a practical tool-kit to support health care professionals with an integrated approach: An integrated assessment for eating and drinking challenges A personalised care plan for each participant to address their specific needs, based on multi-disciplinary and patients focused goals. A defined selection of clinical outcome measures to record change and progress. A personalised patient and carer information leaflet.The results of this study will be shared locally with patients, health care professionals and more widely at national and international conferences. Results will be published in high impact journals, shared on social media and through patient story videos. These findings will determine if it is possible to carry out a future larger definitive national study which will test breakfast group with a wider population.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: STROKE