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Healing Right Way RCT: Novel interventions to enhance the cultural security of rehabilitation services for Aboriginal Australians with brain injury

Armstrong, E., Coffin, J., Hersh, D., Katzenellenbogen, J.M., Thompson, S., Flicker, L., McAllister, M., Cadilhac, D., Rai, T., Godecke, E., Hayward, C., Hankey, G.J., Drew, N., Lin, I., Woods, D. and Ciccone, N. (2022) Healing Right Way RCT: Novel interventions to enhance the cultural security of rehabilitation services for Aboriginal Australians with brain injury. International Journal of Stroke, 17 (Supp. 1).

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Background: Access to rehabilitation services for Aboriginal people following acquired brain injury (ABI) is frequently hindered by challenges navigating: i) complex medical systems, ii) geographical distances from services and iii) culturally insecure service delivery. Healing Right Way is the first randomised control trial (RCT) to address these issues in partnership with multiple health service providers across Western Australia (WA).

Aims: To outline the multicomponent Healing Right Way intervention by providing case studies, and describing challenges, facilitators and implications for rehabilitation services.

Method: This stepped-wedge cluster RCT involved four metropolitan and four regional sites across WA. Aboriginal adults hospitalised for ABI were recruited from 2018-2021. Intervention components comprised ABI-related cultural security training (CST) for hospital staff, and employment of Aboriginal Brain Injury Coordinators (ABICs) to support ABI survivors for six months post-injury. The primary outcome was quality of life (measured with Euro QOL–5D-3L VAS) at 26 weeks. Secondary outcomes included participants’ overall function and disability, anxiety and depression, carer strain, and changes to service delivery across the 26-week follow-up period. Detailed process and cost evaluations were also undertaken.

Results: 108 participants were recruited from the participating sites. The CST was delivered across all eight participating hospitals with 250 hospital staff trained. ABICs supported 61 participants, 70% residing in regional, rural or remote areas. Challenges to implementation of the intervention included impacts from COVID-19 responses, hospital staff turnover and availability, recruitment of people with traumatic brain injury and methods for maintaining contact with participants and next-of-kin across locations. Collaboration with Aboriginal health providers and community networks were invaluable to maintaining contact with participants during follow-up, as was telehealth and research partnerships.

Discussion/Conclusions: This landmark trial provides a novel multicomponent intervention in an underserviced population to inform much-needed service improvements for Aboriginal people with ABI across metropolitan and rural settings.
The feasibility of a short duration, intensive, multidisciplinary and self-managed approach to improve mobility for community stroke survivors

Item Type: Journal Article
Murdoch Affiliation(s): Ngangk Yira Aboriginal Health Research Centre
Publisher: SAGE Publications
Copyright: © 2022 by World Stroke Organization
Other Information: Abstract presented at the SMART STROKES Conference 2022 18-19th August, Sydney, NSW
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