Stroke is the largest cause of adult disability in the United Kingdom (UK), and accounts for 5% of total NHS costs. Early rehabilitation relevant to patients needs can improve independence and the intensity of activity impacts on the degree of recovery, yet national targets to increase therapy intensity and frequency are not being met. In acute stroke units staff, patients and carers can be more involved in increasing supervised and independent therapeutic activity, which has the potential to expedite discharge and decrease dependency on health and social care services in the longer term. National stroke audits have highlighted non-adherence to therapy intensity and frequency recommendations, but cannot help identify solutions.

Aims & Objectives

in the longer term. National stroke audits have highlighted non-adherence to therapy intensity and frequency recommendations, but cannot help identify solutions.

Our research questions focus on the feasibility and impact of patients, carers and clinicians co-producing and implementing interventions to increase supervised and independent therapeutic patient activity in acute stroke units.


The research will be undertaken in three phases.

 In phase 1: We will complete a rapid evidence synthesis to update the evidence on the efficacy and effectiveness of co-production approaches in acute healthcare settings.

In phase 2: We will collect baseline  data on patient reported outcomes of experiences, wellbeing and satisfaction (PROM/PREM) and utilize Stroke Sentinel National Audit Programme  (SSNAP) data to summarise unit performance against national standards. We will record level of stroke severity of patients receiving care in pre and post intervention periods. Non participant observations will be undertaken to examine social, professional and organisational practices and behavioural mapping methods will be used to record type and number of therapeutic activities in each stroke unit in the pre and post intervention periods

We will use Experience Based Co-Design (EBCD) as our co-production approach to design interventions and evaluate the impact in 2 stroke units. We will conduct interviews with staff, patients and carers, and  produce a trigger film of patient narratives. These data will inform the co-production of interventions by patients, carers and staff to increase supervised and independent therapeutic activity.  Post intervention, a review of phase 2 implementation data including observational, behavioural mapping and interview data will inform the decision to proceed to phase 3.

In phase 3: We will implement and evaluate the co-produced interventions developed in phase 2 in a further 2 stroke units.  The same pre and post-test intervention measures will be used to evaluate the impact of implementation.

Process evaluation:

To understand factors influencing development, implementation and embedding of interventions, a process evaluation informed by  the Normalisation Process Theory (NPT) approach will be utilised.

Anticipated benefits of the study include establishing whether EBCD can be effectively employed in acute healthcare and identifying interventions to increase therapeutic inpatient activity which can be deployed in all stroke units nationally and potentially in other settings including elderly care and trauma and orthopaedic wards.


Clarke D, Jones F, Harris R, Robert G, Collaborative Rehabilitation Environments in Acute Stroke (CREATE) team. What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings? A rapid evidence synthesis. BMJ Open 2017; 7:e014650.

Partners & Collaborators


Jones F, Clarke D, Robert G, McKevitt C, Harris R, Cloud G, McDonald A.


Professor Fiona Jones (Kingston and St George’s University of London (Chief Investigator) Professor Ruth Harris (Kings College London), Professor Christopher McKevitt (King’s College London), Dr Geoffrey Cloud (St Georges Hospital Acute Healthcare Trust), Professor Alastair Macdonald (Glasgow School of Art)


01/01/2016 – 31/12/2018

Funding agency

National Institute for Health and Care Research (NIHR)

Further information

For further information please contact Professor Anne Forster

This summary represents independent research funded by the National Institute for Health and Care Research (NIHR) under its Health Services and Delivery Programme (Grant Reference Number HS&DR-13/114/95). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.