Project Summary
Hunter Medical Research Institute in partnership with ADSSI Ltd trading as Maitland Community Care Services has been awarded an ARIIA grant for their project ‘The ESTEEM Program: Implementation and evaluation of an evidenced-based model of stroke recovery in the aged care sector’.
This project aims to implement then evaluate the benefits and sustainability of The ESTEEM Program when delivered by ADSSI - Maitland Community Care Services. The ESTEEM Program was co-designed (built) in collaboration with stroke survivors, carers, health professionals, and creative professionals to support current and future survivors of stroke living in regional areas. This project will see research translation of the evidenced-based paradigm of "environmental enrichment". Exposure to environmental enrichment after stroke facilitates plasticity (re-wiring) of the brain, resulting in better functional recovery after stroke.
The 2.5 hour ESTEEM Program, delivered twice a week over ten weeks, will provide stroke survivors with a combination of physiotherapist-prescribed exercises, socialisation, and creative arts (eg. art OR dance), resulting in regional stroke survivors and carers living with a better quality of life, social networks, and emotional health long after their participation has ended.
This project will support workforce and research capacity building in the aged care sector of this rapidly expanding regional community. Successful implementation of a program of this nature within regional community-based aged care services will provide stroke survivors with sustainable access to recovery and rehabilitation long-term after this grant funding ends.
Project Outcomes
Background and Aims
This project aims to implement, then evaluate, the benefits and sustainability of the ESTEEM Program when delivered by ADSSI - Maitland Community Care Services (ADSSI-MCCS). The ESTEEM Program was co-designed (built) in collaboration with stroke survivors, carers, health professionals, and creative professionals to support current and future survivors of stroke living in regional areas. This project will see research translation of the evidenced-based paradigm of "environmental enrichment". Exposure to environmental enrichment after stroke facilitates plasticity (re-wiring) of the brain, resulting in better functional recovery after stroke.
The 2.5-hour ESTEEM Program, delivered twice a week over ten weeks, will provide stroke survivors with a combination of physiotherapist prescribed exercises, socialisation, and creative arts (e.g. art OR dance), resulting in regional stroke survivors and carers living with a better quality of life, social networks and emotional health long after their participation has ended.
This project will support workforce and research capacity building in the aged care sector of this rapidly expanding regional community. Successful implementation of a program of this nature within regional community-based aged care services will provide stroke survivors with sustainable access to recovery and rehabilitation long term after this grant funding ends.
Aims
- To determine whether it is feasible, acceptable and cost-effective to deliver the co-designed ESTEEM Program within a regional community-based non-government organisation sector model of care.
- To determine what effect stroke survivor participation in the ESTEEM Program has on the independence, mental health, socialisation and overall quality of life of people living with stroke, as well as their carers' burden and quality of life.
- If found to be acceptable, feasible and effective, describe how best to ensure sustainability of The ESTEEM Program within this regional community and other communities willing to participate in upscaling of this model of care.
What We Did
The implementation and evaluation of the ESTEEM program was conducted in the following stages:
Stage 1: Scoping the current situation in the community.
- Pre-implementation interviews were conducted with the ADSSI-Maitland Community Care Services Team to understand barriers and enablers to the implementation process.
Stage 2: Localising the ESTEEM Program
Stage 3: Implementation
Stage 4: Deliver (independently)
- Delivery of the ESTEEM Program with ADSSI-Maitland Community Care Services Commenced in July 2024 and was included within usual care of this service.
Stage 5: Evaluate
- Post-Implementation interviews were conducted with the ADSSI - Maitland Community Care Services Team.
- Post-Program Participant Surveys were conducted.
- Physical outcomes (Short Physical Performance Battery) were collected.
Outcomes
Post-implementation interviews were conducted with the ADSSI-MCCS ESTEEM Team and identified four main themes around feasibility of delivering the program in this regional community:
- “We’ve got a great space here”: location, having the program within one large space, easy access, set up and pack down.
- “There’s like an order to it”: support from the research team, knowledge and experience of the team, defined processes and resources."
- “There’s always sort of a different way”: adapting to the group needs and capabilities, technology challenges.
- “Enriching lives”: providing a sense of community for participants, positive attitudes and influence on recovery (confidence, strength)
Staff delivering the ESTEEM Program through ADSSI-MCCS highlighted the sense of community the ESTEEM Program provides to participants and the observed improvements in mood and attitude as well as physical function of the participants where one participant was able to transition from relying upon the use of a walking stick. Technology and internet accessibility was identified as the largest limiting factor to being able to complete required documentation on site, however this has since been addressed. 44 stroke survivors were referred to the ESTEEM Program with ADSSI-MCCS, of those 27 commenced the Program, and 21 completed the 10-week program.
- Of the 21 who completed the program, 11 have completed post-program surveys 100% strongly agreed that they were satisfied that the ESTEEM Program met their expectations.
- 100% strongly agreed that they found the staff approachable and supportive.
- 91% strongly agreed that it was easy to attend the sessions (and the remaining 9% agreed that it was easy to attend the sessions).
- 82% strongly agreed that the venue was suitable for the group (and the remaining 18% agreed that the venue was suitable for the group).
- 100% identified that they enjoyed socialising with other participants
Physical Outcomes using Short Physical Performance Battery (SPPB) (Pre-program n=20, post-program n=14):
- Mean SPPB Pre intervention: 7.05
- Mean SPPB Post intervention: 8.31
- Complete physical outcome data was collected for 14 people (pre and post program); 9 of 14 (64%) people demonstrated a clinically meaningful improvement in their SPPB score (physical performance).
Participant quotes from post-program surveys (n=11):
- What did you like about the program? “Meeting others that were in the same situation as me, getting me going getting up and doing things. I would recommend the group to anyone. I have enjoyed it so much it has given me a purpose to get dressed up and get up of (a) morning.”
- Any comments on the creative thinking component? “Gave me confidence to try something new.”
- What would make the program better? “The option to stay on, because there is nothing else like it in the community.”
- Anything else you would like us to know? “What ESTEEM has done has given me a purpose. Something to get out of bed for.”
Impact on Aged Care and Workforce
ADSSI-MCCS has implemented the ESTEEM Program within usual care offered by the organisation. Cost calculations to provide the Program within ADSSI-MCCS for this community is being performed. Once this costing is confirmed, stroke survivors could attend the ESTEEM Program using disability support funding or personal funds.
The learnings of implementing the ESTEEM Program within this community in collaboration with ADSSI-MCCS will be utilised in prospective upscaling and implementation within other regional communities.
Resources Developed
ESTEEM Website [freely available to the sector]: During this project, we developed a new ESTEEM Program website, accessible to people living with stroke (catering for changes in vision and communication) to outline the:
- science underpinning the ESTEEM Program,
- the research program and vision
- other service providers delivering the ESTEEM Program
- links to other stroke services and information about the ESTEEM Program including stories and newsletters.
Members of the community can refer themselves to the ESTEEM Program via this website as well. Website link here: https://esteemafterstroke.com.au/.
ESTEEM Program Synopsis [available to sector on request]: Outlining the core elements of the ESTEEM Program.
ESTEEM Implementation Process and Evaluation: [freely available to the sector following peer review and publication in journal – available end of 2025]: Journal publication outlining pre- and post-implementation interview guides and implementation framework on how to embed the ESTEEM Program in a regional NGO service.
Next Steps
With an additional five participants to complete the 10-week program, additional data for physical function (SPPB) and post-program survey will be endeavoured to be compiled. This data will be combined for further analysis, presentation and publication of results. The ESTEEM Program will continue to be delivered at this participating NGO service – ADSSI- Maitland Community Care Services and is set to be available at a site in both Taree and Newcastle within the next 6 months. These sites will all be participating in a Medical Research Future Fund funded clinical trial to determine the effectiveness of the ESTEEM Program for regional stroke survivors.
Key contact for further information