Introduction: Education and support to self-manage modifiable vascular risk factors and stroke recovery is not routinely available to stroke survivors living in regional, rural, and remote communities of Hunter New England Local Health District (HNELHD). We report on the feasibility of a public health quality improvement initiative to address this unmet need.
Methods: A feasibility within-participant study design was used to evaluate the Newcastle-based (metropolitan) Community Stroke Team’s Healthy After Stroke Online (HASO) program between July 2023-April 2024. HASO is a 6-week physiotherapist-led virtual peer-supported group program comprised of (i) education with behaviour change strategies and (ii) exercise. Regional, rural and remote HNELHD stroke survivors were eligible for referral. Health outcomes were collected pre- and post-program [e.g., leg strength (sit-to-stand in 30secs), self-reported physical activity levels (minutes/week)] and risk factor awareness and self-efficacy.
Results: The 108 stroke survivors [mean age 68years (+/-13), 13% Aboriginal and/or Torres Strait Islander, 57% male] referred resided 276km (median, IQR 165-374) from Newcastle. Assessment and education via telehealth-audio was accepted by 94% (n=102) with 55 opting to participate in HASO. There were no adverse events and an 80% completion rate. There were significant improvements in leg strength +4.9 repetitions (95% CI 3.2-6.5, p<0.0001) and physical activity +82.1mins (95% CI 33.5-130.6, p<0.0017) and most participants reported both an increased understanding of their stroke risk factors (88%) and confidence in managing their stroke (93%).
Conclusion: These results indicate that HASO is feasible and has the potential to be effective. The next important step is to compare the cost-benefit of this model against current equivalent in-person programs.
Relevance to clinical practice or patient experience: This virtual model of care ensures equitable access to strategies to self-manage recurrent stroke risk and recovery. It has potential to be modified and replicated for people living with other chronic diseases.
Co-authorship/Co-presentation: Rebekah Pickering and Jenelle Preece