Invited speaker presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Keynote: The Healing Right Way, Stepped Wedge, Randomised Control Trial: Enhancing rehabilitation for Aboriginal Australians after stroke and traumatic brain injury. (#61)

Elizabeth Armstrong 1 , Tapan Rai 2 , Judith Katzenellenbogen 3 , Sandra Thompson 4 , Meaghan McAllister 1 , Natalie Ciccone 1 , Deborah Hersh 5 , Leon Flicker 6 , Dominique Cadilhac 7 , Erin Godecke 1 , Graeme J Hankey 6 , Neil Drew 8 , Colleen Hayward 8 , Deborah Woods 9 , Melanie Robinson 10 , Ivan Lin 4 , Jane White 1 , Juli Coffin 11
  1. School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
  2. University of Technology Sydney, Sydney, NSW, Australia
  3. School of Population and Global Health, University of Western Australia, Perth, WA, Australia
  4. WA Centre for Rural Health, University of Western Australia, Geraldton, WA, Australia
  5. School of Allied Health, Curtin University, Perth, WA, Australia
  6. University of Western Australia, Perth, WA, Australia
  7. School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
  8. Kurongkurl Katitjin, Edith Cowan University, Perth, WA, Australia
  9. Geraldton Regional Aboriginal Medical Service, Geraldton, WA, Australia
  10. Murdoch University, Perth, WA, Australia
  11. Ngangk Yira Institute For Change , Murdoch University, Broome, WA, Australia

Background:  Healing Right Way tested a new model of culturally-secure care for Aboriginal Australians experiencing stroke or traumatic brain injury (TBI). The intervention included cultural security training for hospital staff and an Aboriginal Brain Injury Coordinator service supporting participants/families for 26 weeks post-injury. 

Aims: To test the impact of a culturally-secure intervention model for Aboriginal people with brain injury.

Methods: This stepped-wedge cluster randomised-control-trial recruited Aboriginal adults>18 years hospitalised for stroke or TBI across four metropolitan and four regional hospitals in Western Australia (2018-2021). Target sample size was 312. Primary outcome: improvement in quality-of-life (Euro QOL–5D-3L VAS at 26-weeks post-injury).   Secondary outcomes: percent minimum processes of care (MPC) achieved, occasions-of-service, disability, anxiety and depression, and carer burden. Comparison of aggregated outcomes from the control and intervention arms are reported.

Results: 108 people were recruited (Control n=47; Intervention n=61), 79% from metropolitan sites; 74% were rural residents. The groups (control/intervention) were balanced on most baseline demographic characteristics (median age 55 years; 59% males). Stroke participants predominated, (n=89/82%, TBI (n=19/18%) but with more TBI patients in the intervention group (26% vs control 6%). Data for the 26-week follow-up were obtained for 84 participants (78%; 34 control, 50 intervention). Adjusted analyses showed no statistical differences between groups on the primary outcome measure at 26 weeks.  MPCs were provided more often for intervention than control participants with the adjusted between-group difference statistically significant at 26-weeks (p=0.0376). No between-group differences were evident from non-adjusted and adjusted analyses or other secondary outcomes (e.g. occasions of service, disability, carer burden).

Conclusion: We provide the first Australian data on a culturally-secure model of care for Aboriginal people with stroke and TBI, and improvements in the quality of care for those receiving the intervention. Results must be interpreted with caution since recruitment was impacted by the COVID-19 pandemic and the effectiveness comparisons were underpowered.