Assessing the fidelity of the independently getting up off the floor (IGO) technique as part of the ReTrain pilot feasibility randomised controlled trial for stroke survivors

Abstract

Purpose

Hemiparesis and physical deconditioning following stroke lead to an increase in falls, which many individuals cannot get up from. Teaching stroke survivors to independently get off the floor (IGO) might mitigate long-lie complications. IGO was taught as part of a community-based, functional rehabilitation training programme (ReTrain). We explore the feasibility of teaching IGO and assess participant’s level of mastery, adherence, and injury risk.

Materials and methods

Videos of participants (n = 17) performing IGO at early, middle, and late stages of the ReTrain programme were compared to a manualised standard. A visual, qualitative analysis was used to assess technique mastery, adherence, and injury risk.

Results

Most participants (64%) achieved independent, safe practice of IGO. A good (73%) level of adherence to IGO and low incidence of risk of injury (6.8%) were observed. Deviations were made to accommodate for non-stroke related comorbidities.

Conclusions

IGO was successfully and safely practised by stroke survivors including those with hemiparesis. Trainers should be aware of comorbidities that may impede completion of IGO and modify teaching to accommodate individual need. Further research should assess if IGO can be utilised by individuals who have other disabilities with unilateral impairments and whether IGO has physical, functional and economic benefit.

Implications for rehabilitation

• Falls are common in stroke survivors, and many are unable to get up despite being uninjured, leading to long-lie complications or ambulance call-outs but non-conveyance to hospital.

• Teaching the independently getting up off the floor (IGO) technique to stroke survivors was possible for those with or without hemiparesis, and remained safe despite modifications to accommodate an individual’s needs.

• Individual assessment is needed to check if a stroke survivor is suitable for learning IGO including, but not limited to, their ability to safely get to the floor and to temporarily stand (without support) at the end of the technique.

Keywords:

• Falls
• physical rehabilitation
• hemiparesis
• adherence
• stroke

Acknowledgements

The authors thank the participants of the ReTrain pilot trial, the Peninsula Patient Involvement Group with the ReTrain Stroke Service User Group for their help and the ARNI trainers who delivered the intervention for being so cooperative and willing throughout the video data collection process. Thanks to Tom Balchin from the ARNI Institute for training our trainers. We also thank our Trial Steering Committee: Ailie Turton (University of the West of England), Siobhan Creanor (Plymouth University), Debbie Neal (Bournemouth University), Justin Smallwood (Patient and Public representative), and Gail Seymour (University of Exeter – Sponsor), and our independent clinical trial adverse event adjudicator, Chris Clark.

Protocol Version: 5 Date: 20/04/2016. Published version available here: http://bmjopen.bmj.com/content/6/10/e012375.full

Trial registration number: NCT02429180.

Authors contributions

LH led video analysis work with assistance from AS; LH drafted the original report; KW provided critical feedback and drafted the first version of the manuscript; SD led the research team and supervised LH with AS and RC; RC prepared protocol, ethical submission and amendments, managed the project, contributed to analysis and the writing of this paper; LP drafted protocol and contributed to analysis; RA, SD, and LP provided stroke rehabilitation expertise. All authors commented on and approved the manuscript.

Disclosure statement

The authors report no conflicts of interest.

Data availability statement

Participants did not consent for datasets to be stored or accessed outside of the research team. Therefore, no datasets have been made publicly available.

Additional information

Funding

This work was funded by the Stroke Association, under Grant TSA-2014-03. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust also supported this work. Krystal Warmoth’s time is supported by the ARC East of England.