title: Stroke survivors' experiences of using the Graded Repetitive Arm Supplementary Program (GRASP) in an Australian acute hospital setting: A mixed-methods pilot study.
abstract: OBJECTIVE
  The Graded Repetitive Arm Supplementary Program (GRASP) has been designed to increase the frequency of upper limb therapy sessions occurring without the presence of a therapist. Its use has not been studied when implemented in acute care settings with patients presenting with a stroke within the first week of onset. To investigate patients' experiences of using the GRASP when provided within the first week in an acute stroke setting.
  
  
  METHODS
  A concurrent nested mixed methods design was used. Participants were assessed prior and post the GRASP implementation using the CAHAI-9, the UL-MAS, and the SIS 3.0 physical dimensions and interviewed regarding their GRASP experience.
  
  
  RESULTS
  Participants (n = 8, mean days post stroke =2.75 days, SD = 2.05 at recruitment, mean age = 69.63years, SD = 11.73) used the GRASP regularly while in the acute stroke care setting (mean GRASP use = 28.44minutes/day, SD = 20.40, range = 10-45 minutes, median = 15 minutes). The perceived benefits of the GRASP use reported by patients included 'it's good for your hand', 'they makes other jobs easier' and 'I've got to be doing something'. Categories regarding the participants' motivation to use the GRASP included 'to get my hand better', 'being able to do the things I did before' and 'to get out of here [the hospital]'. Participants experienced clinically significant changes in mean change scores of the CAHAI-9 and UL-MAS at the group level. Wilcoxon Signed Ranks Test revealed no statistically significant changes.
  
  
  CONCLUSIONS
  A clinical trial to evaluate the effectiveness of the GRASP when provided to patients within the first week is recommended.
authors.affiliation: Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Murdolo
authors.affiliation: Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia.
authors.forename: Ted
authors.initials: T
authors.lastname: Brown
authors.affiliation: Department of Occupational Therapy, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia.
authors.forename: Leesa
authors.initials: L
authors.lastname: Fielding
authors.affiliation: Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Elliott
authors.affiliation: Department of Occupational Therapy, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Castles
mesh_terms: D000368:Aged; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D010865:Pilot Projects; D020521:Stroke; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome; D034941:Upper Extremity
keywords: acute care; occupational therapy; rehabilitation services; stroke; upper limb