Staff-Led Feasibility
The repetitions of exercise completed during each class were documented by staff. An audit was conducted to ascertain the amount and type of exercise completed within the class. During the study period people were referred to the exercise program. The mean number of exercise repetitions completed per participant in each class was The number of exercise repetitions completed by participants was highly variable ranging from 0 to per class.
The amount of average exercise repetitions completed in the Weekend Warrior program was large but with significant variability. A nurse-led exercise class is a feasible method of delivering exercise opportunities to individuals in hospital after stroke. Observational studies have consistently shown that individuals in hospital after stroke spend large proportions of the waking day alone and inactive [ 1 — 3 ].
Moreover, during the limited daily active time, activities are normally of low intensity [ 3 ]. This lack of activity may result in a longer hospital stay and impact on functional outcomes. In , an observational study conducted at the site of this study demonstrated that individuals admitted to this stroke unit were particularly inactive during the weekend when therapy staff were not working and therapy areas were closed [ 4 ]. These results are comparable to those reported in a recent systematic review, demonstrating low activity levels on weekends in hospital after stroke [ 3 ].
Being physically active is important in the rehabilitation of movement problems after stroke [ 5 , 6 ]. Physical activity may comprise various aspects such as decreasing sedentary time, performing general daily activities, and completing specific therapeutic activities. There are different benefits associated with the various forms of physical activity. Numerous systematic reviews have demonstrated that more intensive therapeutic activities early after stroke, particularly repetitive task training, are associated with improved outcomes [ 6 , 9 — 11 ].
More specifically, providing additional in-hospital rehabilitation after hours or on the weekend is effective in increasing physical activity and functional outcomes without any adverse consequences [ 12 ]. Despite this body of evidence, recent evidence suggests that completing additional repetitions of task training may not be effective at all time points after stroke and for all functional tasks [ 13 ].
Feasibility of a Nurse-Led Weekend Group Exercise Program for People after Stroke
Further research regarding the required dose of repetitive task training at various time points is needed. To increase physical activity over the weekend on the stroke unit, the physiotherapy and nursing staff at Bankstown-Lidcombe Hospital designed and implemented a physiotherapist-prescribed and nurse-led weekend exercise program, called the Weekend Warriors.
- Feasibility Studies?
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The Weekend Warrior program is a three-level program with each level comprising three exercises. The program focuses on lower limb exercises that emphasise leg strengthening and balance using repetitive task practice of sitting, standing up, and standing and stepping.
Contact information
The development of the exercise program was based on evidence regarding high intensity repetitive task practice [ 5 , 6 , 9 ] and that a group program is an effective way of delivering exercise to people after stroke [ 14 ]. The aim of this retrospective study was to determine the feasibility of a nurse-led weekend exercise program for people after stroke. To do this we retrospectively analysed the number of referrals to the program and the amount of exercise repetitions completed in the program at Bankstown-Lidcombe Hospital over a month period between June and November Data collected was compared to predetermined feasibility criteria.
For the program to be deemed feasible, 1 referrals to the program averaged greater than five per week and were maintained over time, 2 exercise repetitions for each participant within a class averaged greater than 60, 3 minimal variability between exercise repetitions on Saturday and Sunday meant the program was successful in achieving its aim on both days, 4 minimal variability between exercise repetitions within each level of the program and mobility level meant the class was inclusive for participants of all levels of disability.
A retrospective data audit was completed to summarise the number of referrals and physical activity measured via exercise repetitions completed in the Weekend Warrior program at Bankstown-Lidcombe Hospital between June and November The Weekend Warrior program is designed to increase physical activity on the weekend.
Pumped Storage Feasibility and Site Selection
The physiotherapists on the stroke unit select appropriate participants for the program and determine if any modifications of the exercises are needed to participate in the group exercise class. Participants are referred to the program if they are safely able to complete repetitive exercise in a semisupervised environment and have goals related to lower limb activities. There are no exclusion criteria for the program. Participants with cognitive or language impairments are included in the program if they can participate, with support of family or carers if applicable.
Two nursing staff members are rostered to conduct the class on each weekend day by the nursing unit manager.
All nursing staff were included in the roster. The nurses assist participants to the dining room, where the class occurs, and then assist them to set up and complete the prescribed exercise program. Nursing staff have received training in exercise set-up, basic coaching, and procedures for counting exercise repetitions.
They also received an instruction manual including information on how to set up the class and conduct each exercise. Senior nursing staff and management provided ongoing feedback and advice. During the hour class the remaining staff reallocate supervision of patients in the ward environment, including acute patients. Nursing and therapy staff met regularly to discuss the exercise program and resolve any challenges to implementation. The Weekend Warrior program has three levels of difficulty to enable people of all abilities to attend.
Stroke Research and Treatment
Level 1 can be completed in sitting; therefore, people who are limited to a wheelchair can complete this level. Levels 2 and 3 contain exercises in standing with progressive levels of difficulty. All exercises focus on lower limb strength and repetitive practice of functional tasks. The Weekend Warrior program is completed on both Saturday and Sunday for one hour each day. Table 1 provides a summary of the exercises in the Weekend Warrior program.
This study was conducted at Bankstown-Lidcombe Hospital.
UCL Discovery
The hospital has a comprehensive stroke unit consisting of 20 beds. This unit is a colocated acute and rehabilitation unit which sees individuals after stroke through their hospital admission.
The average length of stay on the unit in was Stroke is the most common diagnosis for people on the unit; however, people with other neurological conditions and mixed diagnoses are occasionally admitted. The average age of individuals admitted to the unit is Inpatients complete usual therapy during the week, which commonly includes twice daily physiotherapy in the rehabilitation gym along with occupational and speech therapy.
There is no formal therapeutic activity on the weekend and no therapy staff present and therapy areas are closed. Individuals after stroke admitted to the stroke unit who during their admission participated in the Weekend Warrior exercise program. The physiotherapy and nursing staff on the Stroke Unit at Bankstown-Lidcombe Hospital have conducted the Weekend Warrior program since August , with exercise repetition data being collected from June This procedure has been previously validated at the study hospital [ 16 ]. The participant exercise recording sheet can be seen in Appendix. The total number of repetitions completed by the participant for each exercise on Saturday or Sunday was recorded in the appropriate box within this sheet.
The nursing staff collected the recording sheets after each Weekend Warrior class and they were given to the physiotherapy staff each Monday morning with a general report of the class and any issues that arose. The data sheets were then stored in a secure cabinet in the Physiotherapy Department. Data was entered into a Microsoft Excel spreadsheet with each exercise tabulated for each individual participant and for both Saturday and Sunday sessions.
The amount of exercise completed by each participant was analysed using descriptive statistics including mean, standard deviation, median, and interquartile range IQR. Other participant information from the exercise recording sheets such as program level and physical assistance needed for mobility was also recorded. The variation in amount of repetitions completed per participant between Saturday and Sunday exercise classes and between each program level was examined with an independent -test.
Between June and November there were patients referred to the Weekend Warrior program. Many class participants were referred to the class over multiple weeks with the mean time in the class being 2. Twelve of the participants were referred to the class during more than one admission to the stroke unit.
Fifty eight percent of participants were male. There was a total of individual referrals with an average of 8. There were nine weeks in the study period for which there was no referral data. Sites were filtered through engineering, economic, land use, and environmental criteria in order to evaluate and prioritize their feasibility. Land use and environmental constraints identified by Meridian led to the selection of a small number of sites for further engineering and economic analysis.
Meridian's documentation of site attributes and selection criteria provided a concise summary of the site selection process for project managers. Topographical features, land use designations, microwave signal transmission constraints, maintenance access, and site engineering design parameters were used to identify locations for potential new communication towers. GIS analysis was used to identify 25 potential sites and review all possible microwave signal paths between Juneau and Sitka to identify a handful of feasible locations for field evaluation.
Meridian staff led an engineering reconnaissance survey by helicopter to verify the feasibility of selected sites. Options for safer and more effective structures are being evaluated. Meridian is assessing the environmental compliance ramifications of each alternative to recommend the most permittable option. Meridian was part of the team that evaluated eight sites throughout the basin to assess the following: A direct power line connection to the communication site would reduce costs associated with transporting fuel by helicopter, storing diesel fuel on the mountain-top, and reduce the risk associated with refueling during adverse weather conditions.
Engineering, environmental, land use, and permitting information was used to evaluate route options, followed by field investigations to determine the most feasible route to construct.