Incorporating a group circuit class in an inpatient rehabilitation setting for people who have had a stroke: an implementation study

Background/Aims Clinical practice guidelines strongly recommend that group circuit classes should be used to increase scheduled therapy time for people who have experienced a stroke. The aim of this study was to implement a stroke group circuit class in an inpatient rehabilitation ward and assess its feasibility. Methods The Consolidated Framework For Implementation Research was used to guide implementation. Based on a survey with staff, a protocol was established, staff were educated and trained, and patient timetables were organised. The group circuit class ran twice weekly with a staff to patient ratio of 1:3 with six stations where patients undertook exercises for 8–10 minutes each. Each class lasted up to 90 minutes with 60 minutes of active therapy time. No additional staff were employed to introduce the group circuit class. Key outcomes were reach, effectiveness, adoption, implementation and maintenance. Results A total of 54 participants who had experienced a stroke (31 men and 23 women) were admitted to the inpatient ward from 5 December 2023 to 4 April 2024. There was moderate reach with 70% (38 of 54) attending. Limited effectiveness was demonstrated as a total of 71% (29 of 38) of those who attended the group had a Functional Independence Measure change exceeding the minimum important clinical difference compared to 56% (9 of 16) of those who did not attend. There were nil adverse effects. The group circuit class was adopted by all eight physiotherapists at the inpatient ward and 92% of planned classes were completed with a mean of 5.0 (SD 1.0) participants. The group was maintained six months after its introduction, with 48% of patients admitted to the inpatient ward attending. Conclusions Implementing a stroke group circuit class in an inpatient setting is achievable and did not require additional staffing. However, implementation introduced initial costs including time taken away from clinical work. Implications for practice Implementation of a stroke group circuit class in an inpatient setting is achievable without introducing additional staff when guided by a framework such as the Consolidated Framework of Implementation Research.