# 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

## TL;DR

A study tested cultural training and support for Aboriginal Australians recovering from brain injuries but found no significant improvement in quality of life.

## Contribution

This study evaluates the feasibility and impact of cultural security training and Aboriginal Brain Injury Coordinators in rural healthcare settings.

## Key findings

- Cultural security training and Brain Injury Coordinators improved care processes but not health outcomes.
- Hospital compliance with minimum processes of care improved by 6.8% in the intervention group.
- Quality of life scores showed no significant difference between groups.

## Abstract

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).

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.

Four urban and four rural hospitals in Western Australia, 2018–2022.

Aboriginal adults ≥ 18 years hospitalised with stroke or TBI.

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.

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.

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.

ACTRN12618000139279