AITHM James Cook University

15 January 2020

Every year, 50,000 Australians suffer a stroke. The number of stroke survivors in this country now totals almost half a million, but most battle ongoing disabilities. The annual cost of stroke to the health system is $54 billion. The need to develop more effective rehabilitation strategies to maximise recovery is critical.

JCU PhD researcher, pharmacist Nerida Firth, is investigating what spurs or slows the rehabilitation efforts of stroke survivors – crucial groundwork for the design and implementation of the first randomised clinical trial in northern Queensland to assess the combined use of drug therapy and non-robotic rehabilitation technology to expedite recovery.

Around two-thirds of stroke survivors suffer disabilities to the upper limbs, impeding their ability to perform simple daily tasks such as eating and dressing. The JCU trial will evaluate the ability of certain medications to enhance rehabilitation results – or achieve the same results more quickly – when used in collaboration with the Smart Arm, a mechanical rehabilitation device developed by JCU to help stroke patients regain arm mobility.

In order to recruit participants best equipped to complete the proposed 12-week trial protocol, Ms Firth’s PhD study is delving deep into what motivates stroke survivors to stay the distance, when it comes rehabilitation regimes – and what makes it hard. There are no easy answers, as every stroke survivor’s journey is different, in terms of health complications, including their ability to process what is happening to them and move forward.

“What I am learning is that people don't really understand stroke and rehab, until they are faced with it,” said Ms Firth, who previously worked at the first community-based, university student-led, inter-professional neurorehabilitation facility in Townsville.

“At that point, it is really stressful. You've had a stroke. Your life is turned upside down. You have people scrambling to help you, if you are lucky. And then you are trying to make decisions, when you are vulnerable and may not have sufficient cognitive capacity or support. As researchers who haven’t had a stroke, we can’t make assumptions about how people will react. We might be wrong.”

Ms Firth has conducted focus groups with stroke survivors in the AITHM Translations Research Facility in Townsville, as well as in several other northern Queensland communities, to identify factors that influence their rehab decisions; “basically, what they are prepared to do, in return for what outcomes”.

She plans to further explore patient rehab priorities through an online discrete choice experiment involving stroke survivors Australia-wide; presenting participants with different therapy scenarios and asking which they would choose.

The researcher will then utilise her findings to develop a single case experiment design – a mini version of the randomised clinical trial – which will map the rehabilitation progress of four or five participants, under the trial protocol.

She will seek participants whose rehabilitation journeys vary, in order to reflect the range of therapy pathways that stroke survivors may experience, including movement between hospital rehabilitation units, sub-acute wards, hospital out-patient and community-based rehab centres. This will enable her to assess the feasibility of participants adhering to the trial protocol, wherever they are.

The data that Ms Firth is assembling, with the aid of stroke survivors, will help to build a robust randomised clinical trial that can better assess the efficacy of the new treatment approach by taking into account a spectrum of other issues that may aid or hinder rehabilitation success. The results of the trial could open new doors to stroke recovery.

 “Australia has an aging population. More people are having strokes and more are surviving. So it is important to get the rehab right,” she said.

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