A multifaceted continuing professional development intervention to move stroke rehabilitation guidelines into professional practice: A feasibility study

Capacity building for providers of cognitive rehabilitation in Queensland: a needs analysis survey

Background Cognitive rehabilitation of people with traumatic brain injury is a complex and challenging area of practice. Practitioners working in cognitive rehabilitation require ongoing training to stay abreast of new research and best practice interventions. A needs analysis was conducted to inform the development of a capacity building program for cognitive rehabilitation providers. Methods A cross-sectional online survey of providers of cognitive rehabilitation services in Queensland collected data on demographic information, perceptions of knowledge, skills and confidence in cognitive rehabilitation, previously completed training, desired training opportunities and delivery methods, and barriers and facilitators to engaging in training. Results The 103 respondents included 67 occupational therapists, 17 speech pathologists, 12 psychologists and seven social workers with a broad range of practice experience. Participants perceived a need for further training, with executive function and functional cognition the most desired topics. The number of topics previously trained on was significantly correlated with levels of knowledge, skills and confidence (P   Conclusion Cognitive rehabilitation providers in Queensland reported a need for further training, delivered flexibly, with a focus on managing complex cognitive impairments.

Improving stroke clinical guideline adherence in an Australian hospital using a clinician-led implementation process

BACKGROUND

Private hospitals in Australia manage 11% of acute and 48% of rehabilitation stroke admissions, yet little is known about implementation of stroke clinical guidelines in this setting. Clinical guidelines recommend that acute stroke patients be co-located in a stroke unit in a geographically defined area, rather than dispersed across the hospital.

OBJECTIVE

To investigate post-intervention adherence to clinical guidelines for stroke management, and to explore staff barriers and facilitators to guideline implementation.

METHODS

Observational study before-and-after local implementation of Australian stroke clinical guidelines. The primary outcome was a change in the proportion of patients who were physically co-located in an acute stroke unit. Secondary outcomes included changes in adherence to additional acute and rehabilitation guideline criteria, and staff identification of barriers and facilitators to guide implementation. Data were collected from medical record audits, health service information and staff surveys.

RESULTS

Co-location in an acute stroke unit did not change significantly after guideline implementation (49% adherence pre-intervention and 54% post-intervention). Across acute and rehabilitation wards, 15% (11/72) of guideline criteria improved (p < .05). These related to assessments of swallowing and neglect, presence of a stroke care co-ordinator and occupational therapist, post-discharge care plan, provision of patient education and return to driving. Facilitators to guideline implementation included staff education, collaboration, and dissemination of user-friendly stroke policies.

CONCLUSION

Stroke clinical guideline implementation led to a favorable uptake of some criteria, yet not all. Implementation was assisted by staff education, user-friendly stroke policies and multidisciplinary team collaboration.

TRIAL REGISTRATION

ANZCTR: registration number ACTRN12616000646448 (http://www.ANZCTR.org.au/ACTRN12616000646448.aspx).

Expected Health Benefits as the Ultimate Outcome of Information Available on Stroke Engine, a Knowledge Translation Stroke Rehabilitation Website: Web-Based Survey

BACKGROUND

Electronic knowledge resources are readily available and typically target different audiences, including health professionals and the public, that is, those with lived experience and their relatives. The knowledge-to-action framework, in combination with the information assessment method (IAM), considering both the value-of-information construct and the conceptual model of acquisition-cognition-application, can be used to support the evaluation process of such resources. As an example, Stroke Engine is an evidence-based knowledge translation resource in stroke rehabilitation (assessments and interventions) for health professionals and students as well as individuals who have sustained a stroke and their relatives. According to Google Analytics, the website is perused >10,000 times per week.

OBJECTIVE

With the overall aim to improve the content available on Stroke Engine, we documented Stroke Engine users' perceptions of situational relevance, cognitive impact, intention to use, and expected patient and health benefits regarding the information consulted.

METHODS

A web-based survey anchored in the IAM was made available via an invitation tab. The IAM is a validated questionnaire that is designed to assess the value of information. Sociodemographic characteristics were also collected, and a space for free-text comments was provided. Descriptive statistics were used, and thematic analysis was used for the free-text comments.

RESULTS

The sample consisted of 6634 respondents. Health professionals (3663/6634, 55.22%) and students (2784/6634, 41.97%) represented 97.18% (6447/6634) of the total responses. The remaining 2.82% (187/6634) of the responses were from individuals who had sustained a stroke (87/6634, 1.31%) and their relatives (100/6634, 1.51%). Regarding situational relevance, assessments (including selecting, obtaining, and interpreting results from a test) was the main topic searched by health professionals (1838/3364, 54.64%) and students (1228/2437, 50.39%), whereas general information on stroke rehabilitation was the top-ranked topic for nearly two-thirds of the individuals with stroke (45/76, 59%) and their relatives (57/91, 63%). Cognitive impact was characterized by learning something new. Intention to use was high (4572/6379, 71.67%) among the respondents and varied in context (eg, refine a topic, research, class assignments, teaching, and education). Respondents commented on ways to improve content. Expected patient and health benefits such as improvement in health and well-being was the top-ranked category for all 4 subgroups, followed by the avoidance of unnecessary or inappropriate treatment for health professionals (183/623, 29.4%) and a feeling of being reassured for individuals with stroke (26/75, 35%) and their relatives (28/97, 29%).

CONCLUSIONS

Valuable feedback on Stroke Engine was obtained in terms of its accessibility, relevance for informational needs and retrieval, accuracy, and applicability; however, of utmost importance is the potential implementation of its evidence-based content in clinical practice and the perceived expected impact on patients, their relatives, and their health professionals. The feedback received allowed for corrections and the identification of key topics for further development.

A Stroke Rehabilitation Educational Program for Occupational Therapy Students and Practitioners: Usability Study

BACKGROUND

There are gaps in knowledge translation (KT) of current evidence-based practices regarding stroke assessment and rehabilitation delivered through teletherapy. A lack of this knowledge can prevent occupational therapy (OT) students and practitioners from implementing current research findings.

OBJECTIVE

The aim of this pilot study was to create an educational program to translate knowledge into practice regarding the remote delivery of stroke assessment and rehabilitation to OT students and practitioners. Four areas of focus were addressed in the educational program, including KT, task-oriented training, stroke assessments, and telerehabilitation.

METHODS

Two pilot studies were conducted to assess the knowledge gained via pretests and posttests of knowledge, followed by a System Usability Scale and general feedback questionnaire. Participants in study 1 were 5 OT practitioners and 1 OT assistant. Participants in study 2 were 9 current OT students. Four 1-hour modules were emailed weekly to participants over the course of 4 weeks, with each module covering a different topic (KT, task-oriented training, stroke assessments, and telerehabilitation). Preliminary results were reviewed using descriptive statistics.

RESULTS

Statistically significant results were found with increased scores of knowledge for both students and practitioners. Most of the educational modules had an above-average score regarding value and positive feedback for the educational program as a whole from the participants.

CONCLUSIONS

Overall, the results of this pilot study indicate that a web-based educational program is a valuable, informational method of increasing the translation of knowledge in the remote delivery of stroke assessment and rehabilitation. OT students and practitioners found the information presented to be valuable and relevant to their future profession and current practice.

Effectiveness of electronic learning for continuing interprofessional education on behavior change of healthcare professionals: A scoping review

Electronic learning (e-learning) for continuing professional education (CPE) in healthcare has been shown to improve learners' satisfaction, attitudes, and performance. E-learning outcomes for continuing interprofessional education (CIPE) are less known, and the features of electronic CIPE programs that promote behavior change are unclear. In this scoping review, we sought to identify the program features and areas of behavior change in healthcare professionals using e-learning for CIPE. PubMed, CINAHL, ERIC, PsycINFO, Cochrane Library databases, and Google/Google Scholar were searched for all English articles published in the last 10 years. From the 32 studies included in our review, eight types of e-learning methods were identified. More than 35,542 healthcare professionals of different professions had participated in the programs. Thirty studies demonstrated positive behavior changes, with four areas of behavior changes identified. The most common area of change was in patient care practices. Five common program features facilitating behavior change were also identified. Most successful programs provided interactive and authentic learning experiences, which promoted direct clinical application. Future researche should include monitoring of sustained behavior changes at work, linked to patient outcomes.

Implementation Science Research in Communication Sciences and Disorders: A Scoping Review

PURPOSE

The purpose of this study was to complete a scoping review of implementation science (IS) research in communication sciences and disorders (CSD) over time and to determine characteristics of IS research in CSD.

METHOD

A scoping review was conducted of PubMed and Education Resources Information Center for sources published in English that (a) included CSD practitioners, (b) addressed IS research, and (c) identified a specific evidence-based practice. Resulting sources were systematically examined for study aim, patient populations, implementation framework utilized, setting of the study, implementation strategy examined, and implementation outcome measured.

RESULTS

The majority of the 82 studies that underwent a full-text review (80.5%) were published in 2014 or later. One fourth of the studies were concept papers, and another one fourth focused on context assessment (25.6% of studies, each), 11% focused on designing implementation strategies, and 36.6% focused on testing implementation strategies. The patient population most frequently represented aphasia (21.3%), and most studies (34.4%) were conducted in inpatient medical settings. Nearly half (42.6%) of the nonconcept studies lacked an IS framework. Among implementation strategies identified, approximately one third of studies focused on education and/or training plus another strategy and one fourth focused on education and/or training alone. Implementation outcomes measured typically represented early stages of implementation.

CONCLUSIONS

This scoping review of IS research in CSD described the landscape of IS studies in CSD. IS is intersecting with CSD at a rapid rate, especially since 2014. Future IS research in CSD should adopt an implementation framework a priori and consider the broad range of implementation strategies and outcomes to support the uptake of research into typical practice settings.

Implementation strategies and outcomes for occupational therapy in adult stroke rehabilitation: a scoping review

BACKGROUND

Stroke survivors often encounter occupational therapy practitioners in rehabilitation practice settings. Occupational therapy researchers have recently begun to examine the implementation strategies that promote the use of evidence-based occupational therapy practices in stroke rehabilitation; however, the heterogeneity in how occupational therapy research is reported has led to confusion about the types of implementation strategies used in occupational therapy and their association with implementation outcomes. This review presents these strategies and corresponding outcomes using uniform language and identifies the extent to which strategy selection has been guided by theories, models, and frameworks (TMFs).

METHODS

A scoping review protocol was developed to assess the breadth and depth of occupational therapy literature examining implementation strategies, outcomes, and TMFs in the stroke rehabilitation field. Five electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting the inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer to achieve consensus. The 73-item Expert Recommendations for Implementing Change (ERIC) implementation strategy taxonomy guided the synthesis of implementation strategies. The Implementation Outcomes Framework guided the analysis of measured outcomes.

RESULTS

The initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were described in the included studies. The most used implementation strategies were "distribute educational materials" (n = 11), "assess for readiness and identify barriers and facilitators" (n = 11), and "conduct educational outreach visits" (n = 10). "Adoption" was the most frequently measured implementation outcome, while "cost" was not measured in any included studies. Eleven studies reported findings supporting the effectiveness of their implementation strategy or strategies; eleven reported inconclusive findings, and four found that their strategies did not lead to improved implementation outcomes. In twelve studies, at least partially beneficial outcomes were reported, corresponding with researchers using TMFs to guide implementation strategies.

CONCLUSIONS

This scoping review synthesized implementation strategies and outcomes that have been examined in occupational therapy and stroke rehabilitation. With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the use of evidence-based practices in routine stroke care and describe those strategies, as well as associated outcomes, using uniform nomenclature. Doing so could advance the occupational therapy field's ability to draw conclusions about effective implementation strategies across diverse practice settings.