Abstract

Reframing stroke rehabilitation spaces: a multidisciplinary approach to design evaluation
Many people who have a stroke require inpatient rehabilitation to relearn skills or abilities. Inpatient rehabilitation facilities are often located in refurbished acute medical wards, or have been designed following a model that promotes inactivity and isolation – behaviours that may be detrimental to learning. There is currently no established means of determining how rehabilitation facility design impacts on patients. The aim of this project was to reframe rehabilitation spaces as learning spaces and to develop a structured approach to evaluating the design of inpatient stroke rehabilitation facilities.

This is a complex, subjective problem, and relevant opinions come from many disciplines. This project engaged a multidisciplinary community of experts in neuroscience, healthcare and learning environments, including clinicians, researchers, architects, designers, policymakers and patients. Over two workshops, these experts used Value-Focused Thinking to iteratively identify what they considered important in the design of rehabilitation facilities, and to structure these values into a hierarchy (workshop 1). The experts then suggested appropriate existing measurement tools or approaches to pair with each of these values, any gaps were identified, and Multiple Criteria Decision Analysis was used to rank the suitability of these measurement tools (workshop 2).

Some 28 experts attended workshop 1, and 16 attended workshop 2. The final hierarchy of values suggested that an optimal stroke rehabilitation building should: 1) maximise the efficiency of the facility (including maximising responsiveness of space, minimising cost, and minimising time); 2) maximise the effectiveness of the facility, ie, patients’ outcomes (including maximising opportunities for practicing physical and cognitive function); 3) foster emotional wellbeing of staff, patients and family; and 4) maximise safety. The hierarchy provided new insights into how potentially conflicting values (eg, safety versus opportunities for practicing physical function) could co-exist. The final suite of measurement tools comprised a combination of qualitative and quantitative methods from varied fields, including psychology, design (learning environments and healthcare environments), and rehabilitation medicine. These tools have been combined to create a structured approach to evaluating inpatient stroke rehabilitation spaces.

The combination of Value-Focused Thinking and Multiple Criteria Decision Analysis provided a creative yet systematic methodology for a multidisciplinary question in healthcare design. The results of this project will inform architects and planners of what is important in the design of rehabilitation facilities, and will work to ensure that these spaces support relearning. The new evaluation approach will be piloted in a stroke rehabilitation facility to provide evidence to inform future designs.