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New Rehabilitation Intervention Helps People 
Take Charge Of Their Lives After Stroke

Medical Research Institute of New Zealand (MRINZ) studies show that self-rehabilitation after stroke makes all the difference to positive recovery outcomes. This New Zealand-led research could help hundreds more people become independent after stroke. 

Stroke is New Zealand’s second most common cause of death and the leading cause of serious adult disability. Each year New Zealanders experience a stroke at a rate of around one every 45 minutes. Until recently there have been no proven effective treatments that improve important outcomes such as independence and quality of life once someone is discharged from hospital after stroke.

The development and testing through large clinical trials of the ‘Take Charge’ intervention—a low-cost rehabilitation programme that supports a person to control their own stroke recovery, is a major international achievement for the MRINZ.

The Taking Charge After Stroke (TaCAS) Study, led by Dr Harry McNaughton, MRINZ Stroke/Rehabilitation Research programme director, has provided conclusive evidence that not only does the ‘Take Charge’ self-rehabilitation regimen markedly improve stroke recovery, but it is highly cost effective. The latest TaCAS trial outcomes—an economic analysis, have been recently published in the specialty international journal Clinical Rehabilitation.

TaCAS Study findings assert that if ‘Take Charge’ were implemented widely in Aotearoa New Zealand, an additional 600 people would be independent 12 months after their stroke for basic activities like walking, showering, and dressing, and the health system would save upwards of $9 million each year.

Dr McNaughton, a stroke and general physician currently in Derby, UK says, "Take Charge is all about boosting self-motivation. We have shown that a simple, low-cost tool, in addition to usual community rehabilitation produces remarkable improvements in the sort of outcomes that matter most to people with stroke."

The ‘Take Charge’ programme is undertaken in the home and involves one or two hour-long sessions with a trained facilitator. The ‘talking therapy’ sessions encourage people recovering from stroke to focus on what, and who, is most important to them in order to best plan their own rehabilitation. Each participant, not the facilitator, lead their recovery process, offering autonomy, harnessing self-motivation, and supporting connectedness with others.

The TaCAS Study builds on significant findings from The Māori and Pacific Stroke Study (MaPSS), a landmark MRINZ trial published in 2012, co-led in New Zealand by Dr Matire Harwood and Dr McNaughton. In this unique world-first trial all participants, and the researchers who delivered the study interventions, were Māori and Pasifika.

Stroke burden in Aotearoa New Zealand is greatest for Māori and Pasifika, who have higher rates of stroke, and worse outcomes after discharge from hospital, than European New Zealanders. The inequity of indigenous health and rehabilitation outcomes in stroke requires a comprehensive and multi-faceted response. ‘Take Charge’ has been shown to be particularly effective for Māori and Pasifika participants and is set to make a crucial difference to outcomes such as dependence on others and quality of life for recovering stroke patients from these communities.

Dr Matire Harwood, MRINZ Senior Clinical Research Fellow, programme lead Māori and Pasifika Health, says, “Psychological health and physical well-being are greatly improved when participants, and their whānau, have control over their choices and lives. It’s wonderful to see research supporting health through self-determination underpin the ongoing worldwide implementation of ‘Take Charge’.”

Thanks to the combined findings of these two Health Research Council of New Zealand funded trials, ‘Take Charge’ is likely to be written into international stroke rehabilitation guidelines and become part of standard rehabilitation care for stroke here in New Zealand and many other countries. 

Jo Lambert, Chief Executive of the Stroke Foundation of New Zealand, says, “The ‘Take Charge’ intervention has the potential to improve the lives of stroke survivors in New Zealand and across the world. This unique rehabilitation has the possibility to be widely implemented throughout New Zealand, alongside our existing programmes at the Stroke Foundation."

"The Stroke Foundation supports ‘Take Charge’, which we see as a key evidence-based intervention made freely available by the MRINZ. About 9,000 New Zealanders are hospitalised by a stroke each year and by our estimates ‘Take Charge’ would be an appropriate intervention for about 50-60% of them—around 4,500 to 5,000 people each year. If we can replicate the success of MRINZ’s research, then potentially 600 more people would be more independent after stroke each year, of whom upwards of 100 could be Māori or Pasifika.” says Jo Lambert.

Internationally, trials using ‘Take Charge’ are planned or underway for Indigenous Australians after stroke, using a modified form of ‘Take Charge’ for people with early dementia, and investigating app-based and tele-health versions of ‘Take Charge’ for virtual delivery. 

The ‘Take Charge’ intervention booklet and training manual is available, free to download, from the MRINZ website (www.mrinz.ac.nz/programmes/stroke), so that any rehabilitation service, or individual, can start using it immediately.

People with stroke, and their families, can also read Dr McNaughton’s recently published short novel, Sam's Gift, which tells the story of how ‘Take Charge’ transformed one person's life after a major stroke. All e-book sale proceeds support future Take Charge research.

“The dedicated work of Dr McNaughton, Dr Harwood, and the MRINZ ‘Take Charge’ team has not only shown that this novel approach to patient-centric stroke rehabilitation greatly improves health-related independence and quality of life, but that it is cost-effective and will save money when implemented into public health systems globally.” says Professor Richard Beasley, Director of the MRINZ.

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KEY POINTS AT A GLANCE

‘Take Charge’—a low-cost, participant-centered, self-directed rehabilitation programme significantly improves health-related quality of life and independence after stroke. 
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The latest results of the The Taking Charge After Stroke (TaCAS) trial, led by Dr Harry McNaughton, Medical Research Institute of New Zealand (MRINZ), were recently published in international journal Clinical Rehabilitation. 
 

The study shows if ‘Take Charge’ were implemented in Aotearoa New Zealand, an additional 600 people would be independent one year after their stroke, and the health system would save upwards of $9 million each year. 
 

‘Take Charge’ has been shown to be particularly effective for Māori and Pasifika participants who carry a greater stroke burden in Aotearoa New Zealand—and the programme will now have international application for other indigenous communities.

The widespread implementation of ‘Take Charge’ highlights the impact of MRINZ-led Stroke/Rehabilitation and commitment to Māori and Pasifika health research, adding to significant knowledge and changing clinical practice in New Zealand and internationally.

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BACKGROUND STUDY DETAIL

‘Take Charge’ is a novel, community-based self-directed rehabilitation intervention which helps a person take charge of their own recovery after stroke. ‘Take Charge’ is a ‘talking therapy’ that encourages a sense of purpose, autonomy, and mastery.

A first randomised controlled trial, The Māori and Pacific Stroke Study (MaPSS) looked to see if a single ‘Take Charge’ session improved independence and health-related quality of life 12 months following stroke in 172 Māori and Pasifika New Zealanders. 

The same intervention was then undertaken in a second larger study within largely non-Māori and non-Pasifika stroke participants. The study aimed to confirm whether the ‘Take Charge’ intervention improved quality of life at 12 months after stroke in a different population and whether two sessions were more effective than one.

This second study looked at 400 randomised people within 16 weeks of acute stroke who had been discharged to institution-free community living at seven centers in New Zealand to a single ‘Take Charge’ session, two ‘Take Charge’ sessions six weeks apart, or a control intervention of no sessions.

The Taking Charge After Stroke (TaCAS) trial outcomes show that a 'talking therapy' approach used in the early phase of community stroke rehabilitation, in addition to conventional therapy-led rehabilitation has a statistically and clinically significant impact on stroke outcomes at 12 months after stroke.

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LINKS

TaCAS trial economic analysis paper: https://doi.org/10.1177/02692155211040727

TaCAS main trial results: https://bit.ly/2YY7KZB

Māori and Pacific Stroke Study (MaPSS): https://bit.ly/3mn7n6q

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