Title: Development and feasibility of a clinically integrated behaviour modification toolkit to promote personalised physical activity routines following recent stroke
Funder: Health Education England

Abstract: Background: There are approximately 1.1 million people living with stroke in the UK (Townsend et al., 2012). Increasing physical activity levels improves short and long-term function post-stroke (Saunders et al., 2013), psychological health (Adamson et al., 2004) and modifies cardiovascular risk factors, theoretically improving long-term cardiovascular and metabolic health (Ivey et al., 2007; Moore et al., 2014). Despite the wealth of evidence demonstrating the positive benefits of physical activity post-stroke (Saunders et al., 2013) fewer than 30% of independently mobile stroke survivors undertake even minimal levels of physical activity (Shaughnessy and Resnick, 2009). Stroke leads to complex individual disability creating barriers to physical activity (Nicholson et al., 2013). Current rehabilitation focuses on restoration of function with minimal time and variable levels of health professional expertise in supporting individuals with stroke to be physically active (Mead and Van Wijck, 2011). There is a need to develop and examine the feasibility of interventions to support long-term physical activity specifically tailored to the complex needs of individuals with stroke. Research question: Can physical activity routines be promoted and monitored during the rehabilitation of patients following recent stroke through structured behaviour modification and objective real time feedback? Aims: (1) To review and evaluate current guidelines and services for the delivery of physical activity post-stroke. (2) To explore the use of accelerometers as a tool for motivating physical activity behaviour change in people with stroke. (3) To design and establish the feasibility of a health professional delivery toolkit and matching training for a multifaceted behavioural intervention targeting the introduction and maintenance of physical activity post-stroke. Plan of investigation During Work Package 1 I will review and evaluate current physical activity guidelines and conduct a survey on the current UK delivery of physical activity post-stroke. Work Package 2 will explore the use of accelerometers as a tool to monitor, self-regulate and motivate physical activity post-stroke. The findings of this study and Work Package 1 will inform the design of a set of professional tools and matching training. The tools will enable professionals to assist patients in self-regulating their progress toward achieving PA goals (accelerometer, PA diaries, APP, etc.). The matching online training programme will foster professional motivation and self-efficacy for promoting the safe adoption and maintenance of PA in stroke rehabilitation. Finally the feasibility, acceptability and fidelity of the professional toolkit and training will be assessed in Work Package 3. Potential benefits to patients and NHS: Work Package 1 will inform NHS clinicians and service providers on current physical activity stroke guidelines and UK service delivery. Work Package 2 will establish the feasibility and clinical benefit of using an accelerometer to assist in the self-regulation of physical activity post-stroke. Work Package 2 and 3 will design and establish the feasibility of a professional toolkit and accredited matching online training targeting physical activity post-stroke which will be made freely available to stroke clinicians. The efficacy of the multifaceted intervention developed during Work Package 2 and 3 will be ready for testing in a future multi-centre cluster randomised controlled trial.

Lay abstract: Aim: This work aims to address how health professionals can support people to be more active after a stroke. Background: Stroke is the leading cause of adult disability in the UK. Physical activity levels are low after a stroke; but research shows that being active after a stroke can improve health and wellbeing. A stroke leads to problems with function, mood and thinking, stopping people becoming active again. Helping people who have suffered a stroke to be more active requires specific support which is not there now. Stroke services in the UK tend to focus on function and short-term care rather than helping people start and continue to have an active life. Health professionals need more skills to help them support people with a stroke to be active. Design and methods: I will first assess current guidelines on being active after a stroke to work out their quality and how useful they are. I will then lead a UK survey to find out how health professionals support people with a stroke to be active at the moment. I will also identify areas health professionals need training in. Accelerometers are a cheap and simple tool worn on the arm or leg which detect motion and measure activity levels. Accelerometers are not used in stroke care at the moment. I will explore if accelerometers are a useful tool to help patients check and set activity goals. These findings will be used to help design a toolkit possibly including accelerometers and other physical activity aids (e.g. diaries, mobile phone apps) to help support people to be more active after a stroke. A health professional training programme will be designed to go with the toolkit with advice and plans to assist health care professionals to help patients to be more active. I will then find out whether the value of this toolkit and training can be assessed in stroke services. Long term goal: I will use the findings of the research programme to plan a large long-term study to find out if the toolkit and training can increase long-term activity levels after a stroke and the effect this has on health and wellbeing. Patient and public involvement: Patients and the public have been involved in the design of this research programme and I will engage them during the design and testing of the toolkit and training. Dissemination: I will circulate the research programme in Newcastle upon Tyne, across the UK and around the world to patients and the public via public events, research talks, journals, research meetings, NHS training programmes and press releases. Outcome: The research programme will provide health professionals with skills and tools to support people to start and continue to be more active after they have had a stroke. The programme will also lead to more research working out the effect of the toolkit and training in promoting long-term physical activity and health after a stroke.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;6.7 PHYSICAL
Health categories: STROKE