A Scoping Review of Clinical Practice Improvement Methodology Use in Rehabilitation

Context

The Clinical Practice Improvement (CPI) approach is a methodological and quality improvement approach that has emerged and is gaining in popularity. However, there is no systematic description of its use or the determinants of its practice in rehabilitation settings.

Method

We performed a scoping review of the use of CPI methodology in rehabilitation settings.

Results

A total of 103 articles were reviewed. We found evidence of 13 initiatives involving CPI with six different populations. A total of 335 citations of determinants were found, with 68.7% related to CPI itself. Little information was found about what type of external and internal environment, individual characteristics and implementation process might facilitate or hinder the use of CPI.

Conclusion

Given the growing popularity of this methodological approach, CPI initiatives would gain from increasing knowledge of the determinants of its success and incorporating them in future implementation.

Life habits performance of individuals with brain injury in different living environments

BACKGROUND

Little is known about variations in social participation among individuals with traumatic brain injury (TBI) living in different environments.

OBJECTIVE

To examine the social participation of individuals with moderate-to-severe TBI across various living arrangements.

METHODS

One hundred and thirty-six individuals with moderate-to-severe TBI, living either in natural settings (e.g. home), intermediate settings (e.g. group homes or foster families) or structured settings (e.g. nursing home or long-term care facilities) and requiring daily assistance, were interviewed using the LIFE-H tool, which measures the level of difficulty and the assistance required to carry out life habits and resulting social participation. Participation in six categories of life habits pertaining to Activities of Daily Living and five categories pertaining to Social Roles were examined.

RESULTS

The level of difficulty and the assistance required to carry out the life habits and the overall level of social participation were associated with living arrangements. Participation scores in Activities of Daily Living varied across living arrangements while Social Roles scores did not.

CONCLUSION

Living arrangements (such as intermediate settings) may better support social participation in individuals with TBI. There is a need to further study the issue of living arrangements as they seem to facilitate the performance of life habits, which impacts the social participation of individuals with TBI.

Effect of rehabilitation length of stay on outcomes in individuals with traumatic brain injury or spinal cord injury: a systematic review protocol

BACKGROUND

Rehabilitation interventions are a key component of the services required by individuals with neurotrauma to recover or compensate for altered abilities and achieve optimal social participation. Primary studies have produced evidence of the effect of rehabilitation length of stay on individuals with neurotrauma. However, to date no systematic review of this evidence has been performed. This makes it difficult for managers and clinicians to base their rehabilitation practices upon evidence.

METHOD

Supported by a committee of stakeholders, we will search electronic databases for research articles examining the association between length of stay or intensity of inpatient rehabilitation services and outcomes or the determinants of inpatient rehabilitation length of stay in adults with neurotrauma published after January 1990. Two researchers will independently screen the article titles and abstracts for inclusion. Two reviewers will independently extract the data. Primary outcomes of interest will be level of function, participation and return to work. If the data allow it, a meta-analysis of the studies will be performed.

DISCUSSION

The results of this systematic review will clarify the factors that influence length of stay and intensity of rehabilitation services for individuals with TBI and SCI. They will give clinicians indications for optimal length of stay in these patient populations, contributing to better quality of care and better functional results.

TRIAL REGISTRATION

This review protocol has been registered on the PROSPERO database (CRD42012003120) and is available at http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012003120.

Analysis of the strengths, weaknesses, opportunities and threats of the network form of organization of traumatic brain injury service delivery systems

Networks are an increasingly popular way to deal with the lack of integration of traumatic brain injury (TBI) care. Knowledge of the stakes of the network form of organization is critical in deciding whether or not to implement a TBI network to improve the continuity of TBI care.

GOALS OF THE STUDY

To report the strengths, weaknesses, opportunities, and threats of a TBI network and to consider these elements in a discussion about whether networks are a suitable solution to fragmented TBI care.

METHODS

In-depth interviews with 12 representatives of network organization members. Interviews were qualitatively analyzed using the EGIPSS model of performance.

RESULTS

The majority of elements reported were related to the network's adaptation to its environment and more precisely to its capacity to acquire resources. The issue of value maintenance also received considerable attention from participants.

DISCUSSION

The network form of organization seems particularly sensitive to environmental issues, such as resource acquisition and legitimacy. The authors suggest that the network form of organization is a suitable way to increase the continuity of TBI care if the following criteria are met: (1) expectations toward network effectiveness to increase continuity of care are moderate and realistic; (2) sufficient resources are devoted to the design, implementation, and maintenance of the network; (3) a network's existence and actions are deemed legitimate by community and organization member partners; and (4) there is a good collaborative climate between the organizations.