Background: Over 25% of people who have suffered a stroke experience fatigue as well as limited physical fitness, often resulting from an inactive lifestyle which increases the risk of a reoccurring stroke. To prevent these negative consequences, follow-up care for stroke patients should be more focused on getting fit again after a stroke as soon as possible.
Aim: To improve physical fitness, reduce experienced fatigue and stimulate an active lifestyle of people who have suffered a stroke.
Method: Field research patients N=2, stakeholders N=3 and stroke care experts N=4 has led to the definition as well as the analysis of the issue. An effective intervention was searched in literature, derived from Pubmed, Cinahl and Cochrane. The implementation of the intervention was based on the innovation contingency model, the knowledge value chain scan and Jongbloed’s business plan. This healthcare improvement project was created using the Health Care Model and Behaviour Alteration.
Results: Intervention: A combination of graded activity training and cognitive behavioural therapy seems to be an effective intervention. Research shows that this combination reduces physical fatigue, lowers systolic blood pressure and improves functional health symptoms such as depression, sleep and physical stamina.
Implementation: To prepare the therapist of the department of Rehabilitation at the VUmc to implement the intervention a communication and an In House strategy can be introduced. The results of the knowledge value chain scan shows, not only that determining newly discovered knowledge bares a disconnect in department strategy, it also suggest a disconnect between time and information. To help optimize department strategy and improve time management, whilst successfully completing the project, a brain storm session between management and therapists in regards to strategy and subject knowledge has to take place, resulting in better facilitation and implementation of the project.
Conclusion: Providing graded activity in combination with a cognitive behavioural program for people with fatigue and/or fitness problems following a stroke will improve physical fitness, reduce experienced fatigue as well as stimulate an active lifestyle. To gain knowledge and skills, a pilot will be launched with a small group of patients. This care improvement project reflects the mission of the Rehabilitation Medicine department and can be secured in policy as well as funding.