Exercising, Socialising and Thinking – An Environmental Enrichment Model (ESTEEM) in the community After Stroke

Background

Having a stroke is a life-changing event. Many survivors are left with significant impairments that affect their long-term independence. For many, this can limit their participation in activities which they enjoyed before their stroke.

In metropolitan Australia, stroke patients receive an average of 42 days of therapist-guided stroke rehabilitation. Many people in regional and rural areas receive much less.

This research aims to collaborate with regional community-based providers, to set up a sustainable model of care to support stroke recovery.

What is the research investigating?

We will measure the effect of participating in the ESTEEM Program on walking, balance, independence, thinking, emotional health and quality of life after stroke.

The science of ESTEEM

Environmental enrichment is the combination of physical, cognitive and social activities. Previous experimental models of stroke have shown that this can increase brain plasticity. Brain plasticity is an important process for re-learning skills and function after stroke.

Group-based (peer-supported) programs can provide a sense of community through sharing information, providing tools for coping, and creating an outlet for stroke survivors and caregivers. This may contribute to improved physical function and psychological outcomes after stroke.

Developing and evaluating the ESTEEM Program is a multi-stage process

The ESTEEM Program was co-designed with stakeholders affected by stroke
(e.g. stroke survivors and their carers), therapists and care providers.
The ESTEEM Program launched at Mercy Services in November 2022,
and at Maitland Community Care Services in July 2024.
The research is currently entering Phase 3; an effectiveness trial at three locations in the Hunter New England Local Health District (Newcastle region, Maitland region & Manning Valley/Taree region).

1

ESTEEM:
Phase 1

Co-production

Co-produce with stakeholders a model of environmental enrichment for use in the community setting.

2

ESTEEM:
Phase 2a-(i)

Qualitative focus groups

With stroke survivors, carers, and community care providers.

3

ESTEEM:
Phase 2a-(ii)

Pilot Implementation

Site 1 - Newcastle.
Refine for feasibility testing.

4

ESTEEM:
Phase 2b

Feasibility trial

Wait-list-controlled trial to test the feasibility, safety, efficacy, and sustainability of the program.

5

ESTEEM:
Phase 3

Effectiveness trial across three sites (Site 1 Newcastle, Site 2 Maitland, Site 3 Taree).

Impact potential of the ESTEEM Program Research

Successful delivery of the ESTEEM Program has the potential to support stroke survivors to:

  • Better manage their physical and emotional health
  • Provide a structured means of self-determining their stroke recovery
  • Re-engage with their community

Impact potential on the healthcare system

Accessing the ESTEEM Program in the community setting, outside of mainstream public health services, may reduce the burden on the healthcare system.

Looking to the future

An important aim of the project is to provide a program, which is sustainable and accessible, in regional communities after this research is completed. This may help to improve long-term outcomes and quality of life for those affected by stroke.

How to get involved

If you are interested in being involved as a participant, research collaborator, or financial supporter, click here to visit our page at the Hunter Medical Research Institute (HMRI) for further information.

The ESTEEM Program research
is supported by:

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