In France, more than 150,000 strokes occur each year. Stroke is a major risk factor for dependency, representing the leading cause of acquired non-traumatic disability in adults. Head injuries, which are also very frequent, can leave similar neuropsychiatric sequelae. These events are brutal and their physical, psychological, emotional, social and financial consequences disrupt the lives of patients and their families. Thanks to improved access to thrombolysis and thrombectomy for the management of acute stroke, the prognosis has been profoundly improved. Nevertheless, the increase in post-stroke survival and the evolution of the type of after-effects require the development of support systems dedicated to these post-stroke patients. The same issues are raised for people who have suffered a head injury with similar consequences that require specialised care. Currently, health care is well structured for the acute phase and there is an improvement in the provision of care in specialised rehabilitation services, but the dedicated medico-social provision for people returning home remains insufficient despite the significant needs. The ARRPAC association (Accompaniment, Rehabilitation, Respite after Stroke and Cerebral Palsy) is setting up a new comprehensive medico-social support programme in Lyon (AVanCer programme, opening in June 2022) to improve the autonomy and adaptation capacities of patients and to relieve the social and psycho-affective burden of carers. This experimental day centre, which complements functional rehabilitation and recurrence prevention care, offers adults with brain injury sequelae and their carers therapeutic education programmes, adapted physical activity, social and cognitive remediation and therapeutic workshops, as well as a place for patients and their carers to exchange information and listen. To achieve its ambition, ARRPAC and the AVanCer programme must be integrated into the existing support offer, create partnerships with care structures and evaluate its added value to ensure its sustainability. In case of efficiency and demonstrated benefits for patients, carers and the health system, such a structure could be deployed in other territories. This study evaluates the implementation of the AVanCer programme in terms of its effect on the target audience, participants' experience and implementation according to the REAIM evaluative framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
162
Evaluation of program AVanCer with quantitative and qualitative approaches
Accueil de jour ARRPAC
Bron, France
RECRUITINGGoal Attainment Scaling (GAS)
The GAS will quantify the achievement of the goals set by the patient. It will be calculated at the end of the programme (planned end or premature exit) on the basis of the objectives set when the patient was included in the programme. The objectives and the different steps to reach them are defined in consultation between the patient, the doctor and the nurse. It is a 5-point scale (-2, -1, 0, 1, 2); -2: level before participation, -1: less than expected; 0: expected goal achieved; +1: a little more than expected; +2: best possible outcome expected.
Time frame: Inclusion (Day 0) ; End of the program (between Month 2 and Month 4)
Quality of life of post-stroke patients measured by SIS (Stroke Impact Scale)
This is a specific quality of life scale for patients post-stroke. The scale contains 64 items measuring 8 different domains (strength, hand functionality, Activities of Daily Living ADL/ Instrumental Activities of Daily Living IADL, mobility, communication, emotion, memory/thinking and social participation) and one item assessing overall recovery out of 100. The items are scored using a Likert scale with 5 response options. The score is reported out of 100 for each dimension (100 = no difficulties, 0= maximum difficulties)
Time frame: Inclusion (Day 0) ; End of the program (between Month 2 and Month 4) ; 6 months after the end of the program (between Month 8 and Month 10)
Quality of life of post brain injury patients measured by QOLIBRI (Quality Of LIfe after BRain Injury)
This is a specific quality of life scale for patients post brain injury. The scale contains 37 items measuring 6 different domains (cognitive, affective, functional, relational, physical and emotional). The items are scored using a Likert scale with 5 response options. The score is reported out of 100 (100 = best quality of life, 0 = worst quality of life)
Time frame: Inclusion (Day 0) ; End of the program (between Month 2 and Month 4) ; 6 months after the end of the program (between Month 8 and Month 10)
Depression and anxiety measured by HADS (Hospital Anxiety Depression Scale)
This is a specific depression and anxiety scale of 14 items. The scale contains 14 items of which 7 measure anxiety and 7 measure depression. The items are scored from 0 to 3, giving two scores out of 21 for each dimension; a score above 11 indicates an anxious or depressed state.
Time frame: Inclusion (Day 0) ; End of the program (between Month 2 and Month 4) ; 6 months after the end of the program (between Month 8 and Month 10)
Autonomy measured by modified Rankin score (mRS)
This is a validated 6-level global assessment scale. The score is between 0 et 6, a higher score is associated to a worse outcome.
Time frame: Inclusion (Day 0) ; End of the program (between Month 2 and Month 4)
Walking assessment by 6 MWT (6 Minutes Walking Test)
This is a functional walking test
Time frame: End of the program (between Month 2 and Month 4)
Autonomy in health assessed by the PAM-13 (Patient Activation Measure)
This is a test assessing skills, knowledge and knowledge, skills and confidence in managing one's health. The scale contains 13 items scored on a 4-point Likert scale. The total score is reported out of 100 (100 = maximum activation, 0 = no activation)
Time frame: Inclusion (Day 0) ; End of the program (between Month 2 and Month 4) ; 6 months after the end of the program (between Month 8 and Month 10)
Adhesion to preventive treatment assessed by the Girerd questionnaire
This is a specific self-questionnaire that assesses compliance in 6 items. Each item can be answered by yes or no. For each item, "Yes" scores 0 and "No" scores 1. A final score of 0 means a good observance, of 1 or 2 means a mild compliance problem, and of 3 or more means a poor compliance.
Time frame: Inclusion (Day 0) ; End of the program (between Month 2 and Month 4) ; 6 months after the end of the program (between Month 8 and Month 10)
Quality of life of caregivers measured by SF36 (Short Form Health Survey)
This is a validated scale measuring health-related quality of life. Score is between 0 and 100, A higher score is associated to a better outcome.
Time frame: Inclusion (Day 0) ; End of the program (between Month 2 and Month 4) ; 6 months after the end of the program (between Month 8 and Month 10)
Depression and anxiety of caregivers measured by HADS (Hospital Anxiety Depression Scale)
This is a specific depression and anxiety scale of 14 items. The scale contains 14 items of which 7 measure anxiety and 7 measure depression. The items are scored from 0 to 3, giving two scores out of 21 for each dimension; a score above 11 indicates an anxious or depressed state.
Time frame: Inclusion (Day 0) ; End of the program (between Month 2 and Month 4) ; 6 months after the end of the program (between Month 8 and Month 10)
Perceived burden of caregivers measured by the Zarit questionnaire
This is a self questionnaire assessing the suffering of caregivers. Score is between 0 and 88. A higher score is associated to a worse outcome.
Time frame: Inclusion (Day 0) ; End of the program (between Month 2 and Month 4) ; 6 months after the end of the program (between Month 8 and Month 10)
Reaching the target population evaluated by : 1- The description of the active file : description of socio-demographic characteristics
The indicators are obtained from data collected in the user file. The socio-demographic characteristics collected are: age, gender, family status, professional status, social status
Time frame: Inclusion (Day 0)
Reaching the target population evaluated by : 2-The description of medical characteristics
The indicators are obtained from data collected in the user file. Medical characteristics are type of stroke, treatment and sequelae
Time frame: Inclusion (Day 0)
Adoption : 1-Integration in the territory evaluated by the department of residence of patients
This indicator is obtained from data collected in the user file.
Time frame: Inclusion (Day 0)
Adoption : 2-Link with partners assessed by way of patient referral
This indicator is obtained from data collected in the user file. The type of practioner who referred the patient is collected
Time frame: Inclusion (Day 0)
Adoption : 3-Perception of the structure by professionals
The perception of the structure will be assessed through semi-structured interviews conducted by the research team. The questions focus on the professional's feelings about their participation in the facility and are 30 minutes long
Time frame: Through study completion, an average of 22 years
Adoption : 4-Active patient file : number of inclusions per week
This indicator is obtained from data collected in the user file.
Time frame: Through study completion, an average of 22 years
Implementation 1-Number of patients present compared to the number of patients planned per activity
This indicator is obtained from data collected in the user file.
Time frame: Through study completion, an average of 22 years
Implementation : 2-Follow-up of programs (number of patients per programs)
The follow-up of programs will be described, for each program, by the number of patients per program over time
Time frame: Through study completion, an average of 22 years
Implementation : 3-Deployment of therapeutic workshops : description of workshops
Description of workshops in terms of type of activity , rhythm
Time frame: End of study (Month 22)
Maintenance: 1-Over time at the organisational level by monitoring team meetings
Integration into the medico-social offer in the long term via the partnerships established and maintenance of the activities initiated during the program by the patients measured 6 months after the end of the program
Time frame: End of the program (between Month 2 and Month 4) ; End of study (Month 22)
Maintenance : 2-Evaluation of the sustainability of activities since the end of the program
One question will focus on the continuation of activities and the description of these activities
Time frame: 6 months after end of program (between Month 8 and Month 10)
Cost
Average cost to produce all the support provided by the programme by modelling the pathways
Time frame: End of study (Month 22)
Assessment of transferability
Assessment of transferability using the ASTAIRE grid (Analysis of transferability and support for the adaptation of health promotion interventions) : it contains 4 categories of criteria: description of the population (descriptive criteria of the population), environment (environmental factors likely to influence the effects), implementation conditions (elements of implementation of the intervention, particularly with reference to aspects of planning and partnerships) and support for transfer (elements that make it possible to support the transfer of the intervention and contribute in particular to its adaptation to the new context.
Time frame: End of study (Month 22)
Knowledge of the disease and treatments:
• Knowledge of the disease and treatments: using a knowledge of the disease and treatments questionnaire
Time frame: clusion (Day 0) ; End of the program (between Month 2 and Month 4) ; 6 months after the end of the program (between Month 8 and Month 10)
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