Healing Right Way: A stepped wedge cluster randomised controlled trial aiming to enhance quality of life for Aboriginal Australian survivors of stroke and traumatic brain injury

Authors/Creators

Elizabeth Armstrong, Edith Cowan UniversityFollow
Tapan Rai
Judith M. Katzenellenbogen
Sandra J. Thompson
Meaghan McAllister, Edith Cowan UniversityFollow
Natalie Ciccone, Edith Cowan UniversityFollow
Deborah Hersh
Leon Flicker
Dominique A. Cadilhac
Erin Godecke, Edith Cowan UniversityFollow
Graeme J. Hankey
Neil Drew, Edith Cowan UniversityFollow
Colleen Hayward, Edith Cowan UniversityFollow
Deborah Woods
Mel Robinson
Ivan Lin
Sanita Kratina, Edith Cowan UniversityFollow
Jane White, Edith Cowan UniversityFollow
Juli Coffin

Author Identifier (ORCID)

Elizabeth Armstrong: https://orcid.org/0000-0003-4469-1117

Meaghan McAllister: https://orcid.org/0000-0002-0294-9039

Natalie Ciccone: https://orcid.org/0000-0002-1822-7217

Erin Godecke: https://orcid.org/0000-0002-7210-1295

Neil Drew: https://orcid.org/0000-0003-0911-471X

Jane White: https://orcid.org/0000-0002-9164-2986

Abstract

Objective: To determine the effect of cultural security training (CST) for health professionals and access to an Aboriginal Brain Injury Coordinator (ABIC) for Aboriginal Australians with stroke or traumatic brain injury (TBI). Design: A stepped wedge cluster randomised controlled trial; the intervention package consisted of CST for hospital professionals and 6-month access to ABICs providing education, support, liaison and advocacy; the commencement order of the intervention phase was randomised. Setting: Four urban and four rural hospitals in Western Australia, 2018–2022. Participants: Aboriginal adults ≥ 18 years hospitalised with stroke or TBI. Main Outcome Measures: Primary outcome was quality of life (Euro QOL–5D-3L Visual Analogue Scale (EQ-VAS)) score at 26 weeks post-injury. Secondary outcomes were modified Rankin Scale, Functional Independence Measure, Hospital Anxiety and Depression Scale, Modified Caregiver Strain Index at 12 and 26 weeks, rehabilitation occasions of service, hospital compliance with minimum processes of care (MPC), acceptability of interventions, feasibility of ABIC role and costs. Results: In total, 108 participants recruited (target 312), 75% rural residents; 26-week outcomes assessment completed for 78% of participants. The adjusted mean QoL showed no significant difference (p = 0.83). The MPC outcome favored the intervention group, adjusted difference in means 6.8% at 26 weeks, 95% CI (0.40%, 13.26%). There were no significant differences between control and intervention groups for other secondary outcomes. Conclusions: CST and implementation of an ABIC were feasible, acceptable and improved care processes for a predominantly rural population. Health outcomes did not differ. The effects of the COVID-19 context are discussed. Trial Registration: ACTRN12618000139279.

Document Type

Journal Article

Date of Publication

10-1-2025

Volume

33

Issue

5

PubMed ID

41131785

Publication Title

Australian Journal of Rural Health

Publisher

Wiley

School

School of Medical and Health Sciences / Kurongkurl Katitjin

RAS ID

88254

Funders

National Health and Medical Research Council / Western Australian Department of Health / Royal Perth Hospital Medical Research Foundation

Grant Number

NHMRC Number : 1132468

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Comments

Armstrong, E., Rai, T., Katzenellenbogen, J. M., Thompson, S. J., McAllister, M., Ciccone, N., Hersh, D., Flicker, L., Cadilhac, D. A., Godecke, E., Hankey, G. J., Drew, N., Hayward, C., Woods, D., Robinson, M., Lin, I., Kratina, S., White, J., & Coffin, J. (2025). Healing Right Way: A stepped wedge cluster randomised controlled trial aiming to enhance quality of life for Aboriginal Australian survivors of stroke and traumatic brain injury. Australian Journal of Rural Health, 33(5), e70106. https://doi.org/10.1111/ajr.70106