Poster Presentations


Development of an inter-disciplinary based working party to improve care of the hemiplegic upper limb following stroke within the comprehensive stroke unit

Block H, Crago S

Comprehensive Stroke Unit, Flinders Medical Centre, SA

Background: Occupational Therapists (OT) within the Comprehensive Stroke Unit (CSU) recommend hemiplegic upper limb (UL) positioning, education, provision of slings and alert posters. Audits were carried out to identify adequate hemiplegic UL positioning in stroke patients within the CSU. Baseline audits indicated 62% of patients had adequate hemiplegic UL positioning. Following implementation of an OT designed pictorial alert sheet, hemiplegic UL positioning worsened to 51% of patients with adequately positioned hemiplegic UL's. An inter-disciplinary working party was developed to address these outcomes.

Aim: An inter-disciplinary approach to raise awareness and improve care of the hemiplegic UL within the CSU

Method: Surveys were distributed to ward staff to gain an understanding of staff's level of knowledge regarding hemiplegic UL care. Based on these surveys the working party designed and implemented the following interventions on the ward: Stage 1: theoretical and practical inservices; and verbal and written handover of “L/R Hemiplegic Arm Precautions” by nursing staff; Stage 2: Additional magnet signage above patient's beds and bean bag pillows.

Results: An audit following the inservices and introduction of staff handing over “Hemiplegic Arm Precautions” showed hemiplegic UL positioning had improved with 66% of patients adequately positioned. Hemiplegic UL positioning further improved following the implementation of the bean bag pillows and alert magnets with 94% of stroke patients with adequate hemiplegic UL positioning.

Conclusions: Hemiplegic UL positioning dramatically improved within the CSU following the establishment of an inter-disciplinary based working party and implementation of inservices, nursing handovers, magnet signage and bean bag pillows.

Exploring the introduction of a Rehabilitation ‘Mid-term Report Card’ in communication and education for families of stroke survivors

Loupis YM, Faux SG

Sacred Heart Rehabilitation Service, St Vincent's Hospital, Sydney, NSW, Australia

Background: There has been greater acknowledgement in recent years of the importance of family involvement in improving outcomes for stroke survivors. Stroke rehabilitation can be an emotionally and physically draining experience, and this upheaval does not end at discharge from hospital. A literature review1 analysing material on the purpose and benefits of family conferences, indicated that they are important to the inpatient stroke rehabilitation process, although more can be done to ensure professionals provide best possible care in hospital and in the community. There is a need for better education and ongoing support from interdisciplinary teams for patients and their caregivers, with proactive interventions to reduce strain on patients and families.

Aims: Involving families of stroke survivors in this qualitative research aims to encourage feedback from the treating interdisciplinary team on rehabilitation assessments and progress, as well as trial this new resource. The report card is designed to complement existing practices and be useful for other rehabilitation facilities.

Methods: Recruitment begins in February 2013. Caregivers receive a personalised ‘Mid-Term Report Card’ half-way through the rehabilitation admission, which includes results of assessments and therapies. Four weeks after discharge each caregiver will participate in a semi-structured interview with emphasis on the perceived benefit of receiving the report card, and feedback from caregivers regarding the information they feel most adequately prepared them to assume their caregiving role.

Results: Research concludes in July 2013, with results available for discussion by August.

Therapist education and resources increase use of e-stims and strapping for the prevention of post stroke shoulder subluxation and pain in an inpatient rehabilitation setting

Smith J1, Paxino J2

1Eastern Health, Victoria, 2Southern Health, Victoria

Background: The National Stroke Foundation Guidelines (2010) report level B evidence to support the use of electrical stimulation (e-stims) and strapping to prevent shoulder subluxation and pain post stroke. The National Stroke Foundation resource ‘Implementing the Clinical Guidelines for Stroke Management’ (2010) were used to apply this evidence.

Aims:

  1. Evaluation of barriers that prevent use of e-stims and strapping with the adult stroke population.
  2. Implementation of strategies to increase the proportion of patients receiving these treatment modalities.

Method: On a randomly selected day patient histories were audited to measure the proportion of patients that were receiving either of the two treatment modalities. Surveys of occupational therapy and physiotherapy staff evaluated knowledge and confidence in assessment for and application of these interventions. Education packages and step-by-step instruction resources were developed to address these issues. A post intervention audit was conducted 2 months after the period of staff education and training.

Results: Pre-intervention audit demonstrated 0/20 stroke patients received either e-stims or strapping. Staff survey results indicated staff lacked confidence in assessment for and application of either modality. This was addressed with staff education, provision of step by step instructions and development of guidelines.

Post-intervention audit found that e-stims was indicated in 8/24 patients with a 75% (6/8) implementation rate. Strapping was indicated for 4/24 patients with a 50% (2/4) implementation rate

Conclusions: Provision of staff education and resources increased use of e-stims and strapping to prevent post stroke shoulder pain and subluxation in an inpatient rehabilitation setting.

Reference: National Stroke Foundation (2010) Clinical Guidelines for Stroke Management. Melbourne, Australia; found at http://strokefoundation.com.au/site/media/clinical_guidelines_stroke_managment_2010_interactive.pdf

National Stroke foundation (2010) Implementing the Clinical Guidelines for Stroke Management:’ A guide to changing practice for Stroke Clinicians. Melbourne Australia; found at http://strokefoundation.com.au/health-professionals/tools-and-resources/clinical-guidelines-for-stroke-prevention-and-management/

Prognosticating post-stroke cognitive deficits from pre-discharge EEG

Schleiger E1, Sheikh N1,2,3, Rowland T4, Wong A2,3, Read S2,3, Finnigan S1

1UQ Centre for Clinical Research, The University of Queensland, 2School of Medicine, The University of Queensland, 3Acute Stroke Unit, Neurology Department, Royal Brisbane and Women's Hospital, QLD, 4Department of Occupational Therapy, Royal Brisbane and Women's Hospital, QLD

Overview: Cognitive impairment and vascular dementia are common sequelae of stroke, however their prognostication remains elusive. We analyse the potential of early, quantitative electroencephalography (QEEG) to inform such prognostication. QEEG provides indices of brain (dys)function and has proven informative for prognostication of generalised, post-stroke functional outcomes. Indices sensitive to abnormal, slow delta (1 to 4 Hz) EEG activity are particularly informative in this context. Seventeen patients were recruited to date and informed consent obtained. Resting-state EEG was recorded at 72 hours post-stroke onset using the standard montage of the 10–20 system. QEEG indices including relative frequency band-power and delta:alpha ratio (DAR) were computed offline on three minutes of artefact-free EEG. Cognitive and other assessments were administered at 3 months post-stroke, including the Functional Assessment Measure (FAM) which consists of 12 items probing cognitive, behavioural, communication and other functions. Cognitive items include memory and attention, each scored on a seven-point scale. Associations between sub-acute QEEG and 3-month FAM were investigated using Spearman's correlation analysis. These preliminary outcomes indicate that specific QEEG indices from a standard, sub-acute EEG recording may provide unique insights regarding post-stroke cognitive impairments, and may thus inform clinical prognoses and decisions, for example regarding required levels of care post-discharge.

A community access group in the community rehabilitation setting increases clients’ confidence in resuming independent community tasks

Emmerson K, Houghton S, Sekhon J

Eastern Health, VIC

Background: Following an acute medical event community dwelling people often lose confidence in accessing the community independently due to a number of factors including fear of falls, impaired endurance, or even an inability to communicate. This often leads to them staying at home and becoming reliant on family, friends or external services to assist. In turn, they risk social isolation and reduced opportunity for ambulation, contributing to an overall functional decline.

Aim: To investigate whether an organised multidisciplinary community access group (CAG) within the community rehabilitation program facilitates greater confidence and independence in resuming community activities, such as shopping, banking and use of public transport.

Method:

  1. Benchmarking was conducted with similar services.
  2. Safety visits were conducted by therapists to potential locations.
  3. A referral process was established detailing inclusion and exclusion criteria.
  4. The group was commenced.
  5. Objective and subjective outcome measures were taken and reviewed.
  6. Group processes regularly reviewed and modified.

Results: 95% of attendees reported feeling more confident when going out in the community and 71% had resumed activities they were doing pre-morbidly as a result of the group. No other service was taking a multidisciplinary approach.Process changes included the development of an aphasia friendly goal setting questionnaire and inclusion/exclusion of particular venues.

Discussion: The Community Access Group has allowed a number of people to achieve similar goals in a time efficient manor, as well as providing a social aspect that contributes to greater confidence and support.

The integrated model of therapy: Increasing therapy time in the Stroke Care Unit (SCU) – A protocol

Deery S1, Molan V1, Jupp C1, Wilson N1, Cufer S2, Markus R1

1Acute Stroke Unit, St Vincent's Hospital, Sydney, NSW, 2Nutrition and Dietetics Department, St Vincent's Hospital, NSW

Background: It has been well documented that stroke patients who are admitted to a Stroke Care Unit (SCU) have decreased mortality and morbidity and better functional outcomes post-stroke, than those patients admitted to a general ward. Evidence suggests that the effectiveness of a SCU can be attributed to early intervention, an interdisciplinary team approach (with specialised allied health, nursing and medical staff) and involvement of family in stroke therapy. However, despite our understanding of the components of an effective SCU, patients in tertiary hospitals often receive limited therapy time.

Aims: In this study, our aim is to increase patient accessibility to therapy through an interdisciplinary and targeted approach to the stroke care unit. We have termed this, the Integrate Project.

Methods: Design: Prospective cohort study. This project will involve the collection of baseline data detailing existing therapy time, nursing and family involvement in therapy, as well as staff attitudes towards the current model of care. We will then introduce the new “Integrate” model of care. The components include:

  1. Education for nursing staff regarding the Integrate Project
  2. Introductory sessions for family members run by Allied health staff
  3. Multi-disciplinary team meetings to outline priority patient goals, for nursing staff and family focus
  4. Evaluation and potential re-design of the Integrate model of care components, initiated by the Integrate Project. Interviews will be conducted with nursing staff and families, alongside data collected regarding patient therapy time.

A tool will be developed to facilitate the components of the Integrate model of care. It will include a template with patient specific goals aimed to increase therapy time with nursing staff and families. Inclusion criteria: Patients admitted to the Stroke Care Unit. Exclusion criteria: Patients who have no functional goals. Palliative care patients. Short stay (<2 days) patients.

Outcomes: Our primary outcome measure will be the overall increase in patient therapy time. Our secondary outcomes measures will include: patient, nursing, family and allied health attitudes towards the Integrate model of care; Functional Independence Measure (FIM) on day of admission and discharge from the SCU or day 7; changes to therapists allocation of time; and safety outcomes throughout the implementation of this project.

Conclusion/Discussion: We predict that the Integrate model of care will increase patient therapy time and improve outcomes for patients in the Stroke Care Unit. This project will provide a template to assist in developing high-functioning and integrated Stroke Care Units within New South Wales Health.

Time to rehabilitation post-stroke: The role of the geriatric and rehabilitation liaison service

Matthews, S

Queensland Health

Background: Metro North Subacute Services identified the Geriatric and Rehabilitation Liaison Service (GRLS) as the clinical gateway to Rehabilitation. Established at The Royal Brisbane, Prince Charles, and Redcliffe Hospitals, the GRLS consists of clinicians with specific knowledge and expertise in the assessment of patients’ rehabilitative potential and ongoing care needs, including those post – stroke.

Purpose: The GRLS conducts assessment and manages referral to internal and external rehabilitation providers. By forming a collaborative link across Metro North, including the availability of rehabilitation beds, the GRLS is able to streamline the movement of patients affected by stroke to an appropriate rehabilitation provider in the shortest amount of time.

Outcomes for Redcliffe Hospital GRLS 2012: Redcliffe GRLS mainly refers to Redcliffe Rehabilitation Unit (RRU) and Brighton Rehabilitation Unit (BRU). In 2012 thirty-six patients were admitted to RRU post-stroke. The range of days from acceptance to admission was 0 -10, with average days wait being 3 days. Twenty-five patients were admitted to BRU. The average number of days from the GRLS receiving the referral, and sending the referral to BRU was one day. On average, BRU took one day to accept the referral, and the average number of days from the referral being sent to BRU and the patient transferring was three days.

Discussion: By providing appropriate assessment and referral, and maintaining lines of communication and clinical trust, GRLS has optimised the movement of patients with stroke from the acute ward to an appropriate rehabilitation unit.

Perceptions of leisure within community stroke rehabilitation

Patterson S1, Kelly C1

1Community Adult Rehabilitation Service, Queensland Health, Metro South Health Service District, Brisbane, QLD

Background: It is well documented that participation in leisure activities decreases significantly after stroke. Leisure participation has been linked with increased longevity, self-esteem and mood and has been directly correlated to life satisfaction. Evidence supports the use of targeted leisure interventions post-stroke to improve clients’ leisure participation and general well being, however current models of care appear to be dominated by an impairment based approach. These models of care may restrict community integration by limiting clients’ knowledge and skills to participate in social and leisure activities.

Aim: The aim of this study was to explore allied health practitioners’ views of leisure retraining as a component of stroke rehabilitation, with a particular emphasis on the perceived barriers and enablers for leisure programmes, thoughts on previous leisure group participation and further ideas for leisure retraining within community stroke rehabilitation.

Methods: A qualitative study using focussed, in-depth interviews with a framework approach and thematic analysis was conducted.

Results: Three main themes emerged from the data including the perceived components of leisure intervention post stroke, barriers to implementing stroke leisure intervention and reported outcomes of leisure intervention post stroke.

Conclusion: This research provides further insight into the perceived barriers and benefits of leisure intervention within community stroke rehabilitation. It is anticipated that such knowledge may assist in service delivery planning within the leisure domain to improve outcomes for stroke clients within the community.

Challenges in implementing an early supported discharge model of care for stroke rehabilitation

Grattan-Smith K1, Grant V1

1Royal North Shore Hospital, Sydney, NSW

Background: Early Supported Discharge (ESD) is a proven model of care for the mild-moderate stroke population, and has been employed extensively as best practice in the UK/Europe (Fisher, et al. 2011).

In May 2012 RNSH introduced an ESD program for stroke as a pilot project with the proposal closely based on the UK and European model of care.

The program has been running for 9 months (14 month pilot will be complete by Smart Strokes conference 2013), and has demonstrated varying outcomes to those seen in the UK/Europe.

Purpose: The purpose of this poster is to examine the differences between recruited populations in studies completed in the UK/Europe, and those recruited to the pilot program in the Northern Sydney Local Health District (NSLHD).

  • Patients admitted to NSLHD ESD program have had higher Barthel/FIM scores
  • Smaller percentage of acute stroke patients suitable for the program

The poster will then explore the challenges faced, and the subsequent impact on providing an ESD program in the NSLHD. Some barriers identified include:

  • Minimal community services available
  • High level of carer stress
  • Expectation of a period of inpatient rehabilitation from patient and family

The poster will then review the benefits of a stroke specific home based model of rehabilitation care and discuss suggestions for future pilot programs or studies.

Fisher RJ, Gaynor C, Kerr M, Langhorne P, Anderson C, Bautz-Holter E, Indredavik B, Mayo N, Power M, Rodgers H, Morten Rønning O, Widén Holmqvist L, Wolfe C, Walker M. (2011). A Consensus on Stroke Early Supported Discharge. Stroke. In Press.

Improving post stroke fatigue symptoms in community dwelling stroke survivors – protocol for a pilot program

Elliott K1, McIntosh M1

1Community Stroke Team, Hunter New England Local Health District, NSW

Background: Post stroke fatigue (PSF) affects up to 75% of survivors and can persist two years after initial stroke. PSF can affect a stroke survivor's ability to: engage in rehabilitation, perform activities of daily living, be involved in life situations, be sexually active and return to work. A treatment paradigm found to reduce persistent fatigue in this population was adapted to the needs of our local stroke population.

Aim: This project aims to trial a program which incorporates graded physical exercise and cognitive behavioural therapy (CBT) to reduce the symptoms of PSF of community dwelling stroke survivors.

Method: Eight adult stroke survivors with a score greater than four on the Fatigue Severity Scale (FSS) will be recruited. A multi-disciplinary team will deliver exercise (2/week) and CBT (1/week) to participants in a group setting. Participants will be encouraged to develop goals, keep a fatigue diary and practice mindfulness. Education sessions will be given on fatigue, activity planning and pacing, sleep hygiene, nutrition and exercise. The program's feasibility and acceptability to participants will also be assessed.

Results: The first program will be trialled in July 2013. Outcomes collected prior to and following the 10 week program will include: endurance (6 Minute Walk Test) and lower limb strength, vitality (SF36 Vitality Subscale), fatigue (FSS), mood (Hospital Anxiety and Depression Scale) and quality of life (Stroke and Aphasia Quality of Life). Attendance rates, retention and acceptability will also be measured.

Conclusions: This program will provide pilot data in this much under-researched area. Findings from this project may inform stroke clinicians on strategies to improve survivor management of post stroke fatigue.

Cost efficiency and clinical feasibility of intensive aphasia clinics in Queensland Health setting

Hobson T1, Wenke, R2, Lawrie, M2, Romano, M1, Comben, W3, Ward E4,5, Cardell E6

1QEII Jubilee Hospital, Queensland, 2Gold Coast Hospital, Queensland, 3Ipswich Hospital, Queensland, 4The University of Queensland, 5Queensland Health, 6Griffith University, QLD

Background: Although evidence suggests that intensive treatment for individuals with aphasia is associated with more optimal outcomes, current services in Queensland Health (QH) are frequently delivered through non-intensive means.

Aims: The present project aimed to explore the cost effectiveness and clinical feasibility of embedding three different intensive treatment models for aphasia, being computer therapy, group therapy, and the use of speech pathology therapy assistants (SPTA), at three QH facilities.

Methods: Participant data was analysed using a two cohort comparison design. The first cohort consisted of 20 participants’ who received the standard service of treatment routinely delivered. The second cohort of 30 participants received one of the three different intensive treatment models (provided on average 8.8 hours/week for 11 weeks).

Results: The pro-rata cost of providing treatment per hour per client for the computer and group therapy intensive models was approximately 30% cheaper when compared to the standard service. Both the standard service and intensive models led to significant improvement in participants’ language function however the translation of these improvements in reducing the negative impact of aphasia on everyday life, was significantly lower in the standard service compared to the intensive models. High attendance, low attrition/withdrawals and high satisfaction from participants, caregivers and clinicians alike were found across the three sites providing the intensive models. Key facilitators and barriers were also identified to assist in further implementation and evaluation of the clinics.

Conclusion: The present findings demonstrate the cost efficiency and clinical feasibility of embedding intensive aphasia clinics and further challenge current non-intensive service delivery models for people with aphasia within QH.

Group therapy for stroke survivors with minimal functioning upper limbs

Creevey S

Rankin Park Centre, NSW

Background: A significant proportion of stroke survivors suffer a loss of function of the affected upper limb. Of this group there is a proportion who, either have minimal or no return of functional movement. However, there is minimal documented information regarding the benefits of therapy for this patient group. In this presentation I will present the results of a group therapy program developed specifically for this client group.

Aims: To provide a greater opportunity for stroke survivors who have minimal functioning upper limbs to access evidence based treatment via a group program format.

Methods: Pre and post group measurements are taken including self reported activity levels. Goals for therapy are developed as part of the pre group measurements and are reviewed at the completion of the group. A maximum of 4 patients attend the group at any one time with an Occupational Therapist and Occupational Therapy Assistant.

Each session is structured using the following format: Stretching, strength training (using weights, gravity or active assist); goal directed task specific training utilising imagery, FES and active assist. The group program utilises a multimodal approach.

A home program is provided to each participant incorporating the skills learned in the group and when deemed appropriate, constraint induced movement therapy with the time of constraint gradually increased over the group program.

Results: The expected results are an increase in reported and assessed upper limb function following the completion of the group.

Conclusions: Multimodal group therapy is an appropriate method for delivering evidence based therapy for stroke survivors with minimal functioning upper limbs.

Psychosocial impact following stroke – The role of the social worker in patient recovery

Habermehl M, Coleman M

Social Work Department, Canberra Hospital and Health Services, ACT

Background: Multidisciplinary teams often include a social worker. However, there is limited literature describing the unique contribution that social work provides patients admitted with a stroke, their families and carers.

Aim: To describe the social work role following admission to hospital of patients experiencing stroke.

Method: Social Work complete a psychosocial risk assessment with patients admitted to hospital following a stroke. Family members and/or the carer of the patient are also interviewed in order to develop an overall assessment of the patient's current psychosocial needs.

Results: Social Work provides a number of critical interventions promoting patient recovery. These include assessment; counselling, as often a change in a patient's health status raises new concerns and issues for both patients and their family member or carer; complex discharge planning; advocacy by representing patient's issues and needs to other health care providers and to community services; information and referral about entitlements, services, support groups and resources available in the community.

Conclusion: Social workers provide a valuable contribution to patient recovery by addressing the psychosocial impact following a stroke.

The role of social work in supporting patient recovery following stroke

Coleman M, Habermehl M

Social Work Department, Canberra Hospital and Health Services, ACT

Background: Patients admitted to hospital following a stroke may present with complex psychosocial issues. The unique skill and knowledge base of social workers offers stroke patients, their family members and carers with assessment and evidence based interventions to maximise client recovery.

Aim: To describe the social work role in supporting patients admitted to hospital following a stroke, their families and carers.

Method: Reviews of 20 patient files, identifying social work assessment and interventions.

Results: Data were analysed for 20 patients.

Conclusion: The data produced common themes including assessment, counselling, advocacy, complex discharge planning, crisis support and information and education about entitlements, services, support groups and resources available in the community. Patient outcomes demonstrate that social work intervention plays a key role in stroke patient recovery.

International ongoing stroke trial of Very Early Rehabilitation (AVERT)

Collier JM1, On behalf of the AVERT Trialists’ Collaboration

1The Florey Institute of Neuroscience and Mental Health, VIC

Background: Early and frequent out of bed activity starting within 24 hours of stroke, may be an important component of effective stroke unit care. We hypothesise that early mobilisation will reduce death and disability and be cost effective, compared to standard care.

Aims: To achieve high data quality with ≥90% data completion targets for primary outcomes, and secondary outcomes ≥90% with cognitive and mood tests ≥80%.

Methods: AVERT is a multi-centre, single blind randomised controlled trial. Randomisation is concealed, with stratification by site and stroke severity. Included: Medically stable patients within 24 hours of stroke. Excluded: patients with severe pre-morbid disability and co-morbidities. Early rehabilitation starts within 24 hours, for 14 days. Control group patients receive standard care. Primary outcome: 3 month modified Rankin Scale. Sample size is 2104 patients (n = 1052 per group). Analyses will be intention to treat.

Trial status: 54 hospitals are participating in 5 countries. At February 2013, 31074 patients have been screened with 1530 patients recruited. Recruited patients: mean(SD) age: 70.5(12.9) years; male: 62.9%; first stroke: 81.6%; infarct 87.5%; mean(SD) NIHSS: 8.8(6.4); rtPA: 21.6%. 1422 patients have completed 3 month follow up. Primary outcome completion 99.6%, Secondary outcome completion 92.0–99.9%, cognitive 83.0% and mood 81.4%.

Discussion: The trial data quality is high and is exceeding data completion targets. The Data Monitoring Committee has met 9 times and no safety issues have been identified. We aim to complete recruitment in December 2014.

The StrokeLink program: Linking evidence to practice in QLD for the past 5 years

Hill K, Page M, Herzig M, Wright L, Egan J, Lalor E

National Stroke Foundation, Melbourne, VIC, Australia

Background:StrokeLink is a team based quality improvement (QI) program that the National Stroke Foundation (NSF) has been developed and delivered since 2008. StrokeLink is designed to facilitate reducing the gap between evidence (as outlined in the guidelines) and practice (as found in the national stroke audit).

Aims: To evaluate the usefulness of StrokeLink at a site level over the last 3 years.

Methods: A survey developed for the initial evaluation in 2009 using quantitative and qualitative evaluation was repeated. All sites who have participated in the StrokeLink program were asked to participate via passive (email) and active (face-to-face) means.

Results: This evaluation is currently being undertaken and results will be finalised by the conference.

Conclusion: The initial evaluation concluded StrokeLink was an innovative program which stimulated useful review and improvement of care and facilitated team consensus processes. The follow up evaluation demonstrates StrokeLink continues to be a useful program to support clinical improvement and team development.

Sex, drugs and the medical role: A case report about a stroke survivor with expressive dysphasia

Hamam N

Charles Sturt University, NSW, The University of Sydney, NSW

Background: It is sometimes assumed by health professionals that stroke survivors will raise important concerns; however, this does not always occur, especially with sexual matters. This case report highlights the importance of the health professionals’ role in creating a comfortable environment for stroke survivors to raise concerns about sex.

Case Details: A 64-year-old man with a history of stroke and expressive dysphasia participated in a qualitative research study on sex after stroke. He had been experiencing sexual dysfunction for four years and wanted to know if this was the result of the stroke. Discussions with the man were difficult due to his communication problems however; it was suspected that a change in prescribed medicine might alleviate the problem. The researcher asked him to re-visit his GP who reviewed his medications and changed a prescription. Sexual function returned within a week.

Implications: Sexual dysfunction frequently results from regularly prescribed medications. This case highlights how simple it can be to resolve a sexual concern and how important it is that doctors and health professionals routinely raise the topic of sexual function with patients. Additionally, this case demonstrates the value of allowing people with language problems to participate in research.

Motivational interviewing – Dealing with difficult conversations and maximising patient engagement

Pyle K, Wright L, Page M and Hill K

National Stroke Foundation, Melbourne, Victoria, Australia

Background: The Clinical Guidelines for Stroke Management notes that motivational interviewing (MI) is useful for delivering tailored lifestyle modification advice and there is growing evidence that MI benefits patient mood and mortality post stroke. A needs analysis indicated that clinicians would like to better understand how MI skills can be used for realistic prognosis, goal setting and difficult conversations such as sexuality.

Aims: To present an evaluation of the workshop ‘Difficult conversations in stroke care – using motivational interviewing to improve the patient experience’.

Methods: Two half day workshops were developed and delivered with a post workshop evaluation form completed by participants.

Results: 82 Participants from a range of disciplines attended the two workshops. Feedback was very positive in all areas of evaluation. More than 80% of participants felt the workshop helped them identify gaps in their knowledge about patient communication. Confidence levels between the predisposing activity which self-assessed their confidence to have difficult conversations concerning prognosis, goal setting and sexuality and the evaluation increased. The majority (79%) of participants rated the learning objectives as ‘entirely met’. Many participants reported they intend to incorporate MI skills into their clinical practice and intended to focus more on their individual patient's needs and goals.

Conclusion: Feedback indicates MI is a useful approach and the National Stroke Foundation is considering coordinating further workshops across Australia.

Footnotes

  1. 1

    Accepted for publication in the Journal of Stroke and Neurovascular Diseases in 2013

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