Developing strategies for improVing OutComes And Living well with people living at home with Stroke (VOCALS study).

Research questions What informal activities do stroke survivors use at home to support recovery? How might these be optimised and spread to support personal agency, address current gaps in rehabilitation services and enhance outcomes? Background Stroke is very common. It affects 113,000 people every year, leading to long-term disability and complex health needs at considerable cost. Guidelines require stroke survivors' rehabilitation goals are reviewed regularly for a year, then annually, but these are often missed so stroke survivors engage in activities at home like folding laundry, doing jigsaws, or playing games to aid recovery without professional help. Such activities may represent enriched environment activities (EEAs) because they help improve physical, cognitive, and social recovery, potentially improving rehabilitation outcomes and reducing future stroke risk; however, our knowledge of them is limited to hospitals. Aims and Objectives Aim: To work with stroke survivors living at home and other stakeholders to: 1. Determine opportunities for enhanced stroke rehabilitation provision by identifying the self-initiated enriched environment activities (EEAs) used by stroke survivors at home and subsequently explore the potential of these. 2. Develop and share accessible EEA-based, low-cost strategies for supporting rehabilitation, independent living, and reducing recurrent stroke risk, to support self-agency and inform future scalability. Objectives – To work with stroke survivors living at home and at least 3 months post-stroke to: a) Identify activities they use informally to support rehabilitation and functional recovery and explore to what extent they could be identified as EEAs. b) Evaluate the perceived utility of these activities for enabling living well and independently at home. c) Determine how the identified EEAs could be improved and used to enhance rehabilitation outcomes more widely to facilitate independent living, by enhancing current discharge information. Methods These are specifically designed for researching under-researched topics with marginalised groups and improving healthcare quality (The Silences Framework, The Model for Improvement). They involve: documentary analysis of current discharge advice across England following a stroke; interviews with 20 stroke survivors to identify the EEAs they use (Group 1). Testing of EEAs at home over several weeks and final interview, by/with another 12 stroke survivors (Group 2) will inform the co-design of an easy-access EEA toolkit for home use and enhanced hospital discharge guidelines. Data analysis will involve descriptive statistics and Thematic Analysis. Timelines for delivery The documentary analysis and interviews will be completed month 8 (WPs 1 & 2); EEA testing and co-design of an accessible EEA toolkit and guidance (WP3 months 9-16); and dissemination (WP4 months 17-18). Anticipated Impact and Dissemination Established organisations e.g. Stroke Association will be key partners in disseminating study findings and implementing the impact plan. Tailored activities e.g. roadshows, social media, and publications/conferences will be co-created with the PPI Co-applicants/stakeholders including: Royal College of Occupational Therapists; Centre for Ethnic Health Research, NHS England. Anticipated impact includes: enhanced stroke survivor agency and functional recovery; increased control (i.e. home environment, reduced rehabilitation-related travel/time costs); evidence-based best practice EEA-based discharge guidelines used by service leads/policymakers, and greater public awareness of stroke survivor-initiated EEAs.