One year long Brunel University research study into ARNI Approach finishes

On the 21st October, a year long study looking at the efficacy of the ARNI Strategies completed.
Each Friday since July 2010, Dr Balchin and various ARNI instructors in North West London trained stroke survivor groups at the Hillingdon Sports and Leisure Complex. 
The evaluation and training was sponsored by the Hillingdon Council. The Hillingdon Hospital physiotherapists (lead therapist Jackie O'Dowd) identified 4 groups of 6 to 8 community stroke survivor each. Each group received twelve weeks of training by Dr Balchin and instructors. 

The evaluation was performed by the Brunel University team (Drs Cherry Kilbride, Meriel Norris and Amir Mogedeghi). The preliminary results were accepted as a late-breakinng trial for the UKSF Conference. Early indications suggest that functional balance (Berg Balance Scale) and timed walking (10m walk test) have improved. Data from completed focus groups identified a positive influence of inclusion in the classes. Specifically participants highlighted the benefits of the ‘normality’ of the exercises and the variety of abilities and people within the group. 


Here is just one write up from our files, from a stroke survivor's husband:



Neil Gordon - husband of stroke survivor trained by ARNI
I am perforce the full-time carer for my wife Birgit Gordon who had a major stroke in early April 2010.  Until that event I was the CEO of my own international Food and Agricultural Marketing company and travelling extensively in the UK and abroad.


My wife has participated in a Hillingdon Council supported ARNI Stroke Rehabilitation course during the last three months of 2010.  The manual is being used by me in a domestic situation as a guide and enhancement to the rehab exercises demonstrated on that course.


This is a superb training manual with a very extensive range of exercises and techniques clearly described. As a specialist training manual for those running and demonstrating physical stroke rehabilitation techniques in a gymnasium, it is to be hoped that this manual will be become a “bible”.


At a domestic level it is easy for an individual survivor or carer to absorb and put into practice for the stroke victim – in my case for a 73 year old lady unused to significant physical exercise. The ARNI-directed course at the excellent Hillingdon Leisure facilities has been superb for my wife, her self-confidence and well-being, and I observed at several levels for the other eight or nine survivors:


1    Providing an environment of trusted instructors and support in a perfect location. It was also significant that this was outside the daily personal relationship of the carer.
2    The instructors themselves clearly demonstrated the exercises and techniques, and the safe way to perform them while providing physical support for those who needed it.
3    The peer pressure and companionship of other stroke survivors was a huge accompaniment to the exercises demonstrated. Furthermore the fact that the inspirational leader, Tom Balchin, himself was a stroke survivor and able to show what he had achieved – albeit much younger than most and a highly motivated individual!
4    As we are all very well aware the recovery from a stroke is different for each individual according to severity of the physical and mental impairment suffered, the individual age and motivation, and the acceptance of the benefits of practice and exercise. This stroke rehabilitation exercise programme has to be seen in the context of a fully rounded rehabilitation effort by several agencies including the hospitals, the GPs, physiotherapists, psychiatrists, speech and language professionals, etc.  I clearly observed that the ARNI programme supported the stroke survivors in various ways including bringing together a group of survivors with many similar issues, providing a forum for them to discuss some of these issues while providing a real sense of achievement from the exercises themselves. This rounded benefit is in my experience not being achieved by any of the other agencies which are unable to provide a sense of co-ordination.


Birgit has made great strides in her ability and confidence to perform “seemingly insignificant” (though important for her personally) activities including cooking for eight people at Christmas, looking after a 2 year old grandchild, carrying a vacuum cleaner down the stairs, etc.  All this is contributing to the possibility of us rebalancing our previously very full lives. Thank you for helping to bring back my wife of more than 40 years!  We both look forward to continuing the programme.

The ReTrain Project- ARNI Strategies undergoing Efficacy Evaluations

The ReTrain Trial

Click logo for ReTrain news page

ARNI was developed by a stroke survivor, Dr Tom Balchin. It uses strength and cardiovascular exercises, with a particular focus on specific tasks and controlled body movements to facilitate functional activities. It seeks to “de-medicalise” stroke management in the community by being a stepping stone from NHS-based treatment to self-management and participation in mainstream fitness and well-being activities. See http://www.arni.uk.com/ for further details. 

Instructors are accredited after a 5-day course, an examination and completion of a practical case study. The ARNI approach had been piloted in small group exercise sessions organised through Local Authorities, Third Sector organisations and NHS bodies in various parts of the UK. ARNI instructors are also providing private 1-1 training with stroke survivors. There is a good deal of anecdotal evidence of the benefits of ARNI, even many years after a stroke. However, little formal evaluation of the approach has been conducted.

This study emerged from a suggestion made by James Irving (shown above), a member of what is now called the South West Stroke Research Network (SRN) Patient, Carer and Public Involvement Group.

James had a stroke several years ago, when he reached the end of his NHS rehabilitation he felt that he had been ‘left in limbo’.  He heard about Action for Rehabilitation following Neurological Injury (ARNI) and wanted to know more.  In collaboration with the local SRN manager, Jacqueline Briggs, a research question was developed that asked ‘Does ARNI work?’ and the project was named ReTrain (Rehabilitation Training).

The ReTrain question was further developed with help from Dr Andy Gibson and Kate Boddy, as part of the Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC).  Andy and Kate run the Patient and Public Involvement Group for PenCLAHRC.

The research question was adopted by PenCLAHRC in late 2009 and Dr Sarah Dean became the academic lead for the study.  Sarah convened a research team who worked up a ReTrain proposal that focused on answering the question ‘Is ARNI effective, and cost-effective, in improving function, activity and participation in people who are at least six months after their stroke.

In June 2010 a funding application for a £2.1 million multicentre trial of ReTrain was made to the Health Technology Assessment funding stream of the National Institute for Health Research. In October we heard that the funding bid was unsuccessful. In preparation for the trial some preliminary development studies were planned by Sarah and Dr Vicki Goodwin.  Although we did not get the HTA funding PenCLAHRC agreed to support the development through the appointment of a research fellow Dr Leon Poltawski.  2 Instructors in the South West have been Accredited now in ARNI Approach in readiness for further work.

Below is an October 2011 Update:

STATEMENT FROM DR SARAH DEAN AND DR LEON POLTAWSKI at the  Peninsula College of Medicine & Dentistry, Exeter.

We are a research group with a particular interest in long term stroke survivors. We are part of a collaboration between universities and NHS organisations in Southwest England, called the Peninsula Collaboration for Leadership in Applied Health Research and Care, or PenCLAHRC for short (http://clahrc-peninsula.nihr.ac.uk/).

Many of the research projects run by PenCLAHRC arise from suggestions made by local people and health professionals. One member of the public, himself a long term stroke survivor, suggested that we take a look at ARNI and so we are doing some development work to build a case for a formal research trial of the ARNI programme.

Currently, ARNI is used in various parts of the country in group classes for stroke survivors, often run in local community centres by physical trainers. But ARNI was originally designed to be delivered one-to-one, and so we are running a small number of case studies to examine how well this works in practice. We are interested in answering several questions: does ARNI promote physical health? does it increase confidence? does it improve the quality of life of stroke survivors? We are also asking people what kind of exercise programme might work best for them: one to one or group; at home or in a centre; and who should provide the training. We are also developing a map of the ARNI programme to see if it has particular ingredients that make it unique.

Building up the case for a funded scientific study of ARNI is a slow and laborious process; but we hope that – alongside work being done by other researchers – this will contribute to the development of better services for long term stroke survivors, many of whom feel that they have been forgotten about.