Time is Function. Company LOGO. what we ve learned. I m hoping today has been an opportunity to take time out from the constancy of work and get your.

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1 Time is Function Company LOGO what we ve learned I m hoping today has been an opportunity to take time out from the constancy of work and get your. Isobel.Hubbard@newcastle.edu.au July 2012

2 in the next 30 minutes we ll re-cap today s learning about: Approaches to maximising recovery Applying evidence into practice Cognition: more than just a passing thought Adhering to clinical guidelines Accurately predicting recovery Sample case study Apply into practice And after that. IJ Hubbard 2012 IJ Hubbard March 2012

3 Company Following.. LOGO time for change The 3x3 Hypothetical: As a group we ve been asked by the NSW Agency for Clinical Innovation (ACI) to reflect on the health care that patients with stroke receive between day 3 and day 30 (sub-acute), and, applying an evidence-based approach, to find consensus on: 3 overall objectives of good stroke care 3 evidence-practice gaps to resolve by July performance indicators that describe best practice Rule: No discussion about increased staffing, resources or funding Isobel.Hubbard@newcastle.edu.au July 2012 You re invited to visit Isobel s blog at strokelink.wordpress.com

4 time to thank You for coming to this workshop ACI and Mark Longworth SSNSW & Ed & Prof Dev Committee Presenters: Fiona and Sherree (left mid-day) Clinical Guideline Debate teams All feedback appreciated All workshop resources will be available on. IJ Hubbard 2012 IJ Hubbard March 2012

5 maximising recovery Clinically Proven Approaches Evidence-based approach: Am I doing the right thing to the right person in the right way and at the right time? Tests our beliefs and norms against science Stroke Unit Care: 20% improvement Nothing else is as accessible and effective!!!! Multi-professional team approach Task-specific, client-centered approach Time is Function: patients doing Time is Function IJ Hubbard 2012

6 evidence-practice gap Challenges facing Clinicians Overcoming the hot/cold clinical dilemma Improving on natural history Reviewing zero tolerance on falls Factoring in the brain s ability to reorganise Stroke: upstairs problem with upstairs solution IJ Hubbard 2012

7 stroke rehab resources Barnes et al: Recovery after Stroke (2009) One third of people after stroke, having survived the first few weeks, return home with significant residual disability, and can therefore benefit from an active, multidisciplinary rehabilitation programme. This is a comprehensive guide to rehabilitation after stroke... Amazon Books: A$130 (soft cover) Isobel is a co-author of the Movement chapter in this book. LM Carey: Stroke Rehabilitation: Insights from Neuroscience and Imaging (2012) informs and challenges neurologists, rehabilitation therapists, imagers, and stroke specialists to adopt more restorative and scientific approaches to stroke rehabilitation based on new evidence from neuroscience and neuroimaging literatures... Amazon Books: A$120

8 worth a thought Cognition: more than just a passing thought Assessing dysfunction and improvement Using standardised & non-standardised assessments Apply clinically proven interventions Psychological Management of Stroke (2012) NB Lincoln, II Kneebone, JAB Macniven & RC Morris (2012); presents a review and synthesis of the current theory and data relating to the assessment, treatment, and psychological aspects of stroke.. Amazon.com Books: $A Dr Ian Kneebone presented at the NeuroRehab World Congress, Melbourne 2012 IJ Hubbard 2012 IJ Hubbard March 2012

9 clinical guidelines Stroke Foundation s Clinical Guidelines Nationally-agreed recommendations Adhere to the NHMRC s guidelines Adherence improves patient outcomes (1) Clinical Guidelines for Stroke Management 2010 Backed-up by a bi-annual audit process Concise guidelines: discipline-specific Dietetics, Nursing, Occupational Therapy Physiotherapy, Psychology, Social Work Speech Pathology Caveat: discipline-specific summaries are most effective when all members of the team work in an interdisciplinary and coordinated way. Ref: (1) Hubbard et al (2012) Adherence to clinical guidelines improves patient outcomes.. Arch Phys Med Rehabil, 93: IJ Hubbard 2012

10 predicting recovery Hypothetical Recovery Predicting Rubric Recovery Potential Poor Medium Good Stroke type Total Anterior Cerebral (TACI or TACH) Partial Anterior Cerebral (PAC) Lacunar Infact (LACI) Posterior (POCI) Supportive family No perhaps Yes Incontinent Yes Acute only No Corticospinal tract integrity Minimal or no evidence Some evidence Lots of evidence Global aphasia Yes No Received Stroke Unit Care No Similar care Yes Discharge FIM score (1) Probability of going home Highly unlikely Unclear Highly likely Elephant in the Room: Is there a group of patients with stroke who we simply should not be treating? Ref: (1) Hubbard et al (2012) Adherence to clinical guidelines improves patient outcomes.. Arch Phys Med Rehabil, 93: IJ Hubbard 2012

11 keeping the plates spinning Managing Competing Demands Patient-based: competing health needs Department -based: review your job description Institution-based: not patient-centered Discharge driven to meet the institutional needs Culture values busy ness & stress (badges of honour) Pressure to work unpaid hours Note: Your health and well-being is important to all stakeholders IJ Hubbard 2012

12 sticking my neck out!! Case Study: Ms Smith, 75y, lives alone PACI, 1 st stroke, UL-MAS=8/18, supportive family Recovery rubric: potential to recover well and go home Client-centered: COPM identifies 5 important tasks (20min) 1) Dressing independently, 2) playing the piano, 3) preparing meals, 4) going home, 5) being able to use the local buses Assess function/participation in these tasks (2x20min) In collaboration with Ms Smith, create & agree to: An intensive, constraint-based, task-specific treatment regimen A signed, keep active contract of activity goals An inpatient journal of all activity achieved Two 20 minute/week face-to-face sessions One 20m/wk review of progress IJ Hubbard 2012

13 Company Following.. LOGO time for change Time is Function The 3x3 Hypothetical: As a group we ve been asked by the NSW Agency for Clinical Innovation (ACI) to reflect on the health care that patients with stroke receive between day 3 and day 30 (sub-acute), and, applying an evidence-based approach, to find consensus on: 3 overall objectives of good stroke care 3 evidence-practice gaps to resolve by July performance indicators that describe best practice Rule: No discussion about increased staffing, resources or funding Isobel.Hubbard@newcastle.edu.au July 2012 You re invited to visit Isobel s blog at strokelink.wordpress.com