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Levine R, Zingelman S, McSween MP, Shrubsole K, Hill AJ, Copland DA. Allied Health Clinicians' Uptake of Evidence in Stroke Rehabilitation: A Systematic Review of Determinants Targeted in Implementation Studies. Arch Phys Med Rehabil 2024; 105:988-999. [PMID: 37666287 DOI: 10.1016/j.apmr.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE This study aimed to determine whether targeting specific implementation determinants is associated with allied health clinicians' uptake of evidence when implemented within stroke rehabilitation settings. DATA SOURCES 7 key databases were searched to identify articles published between 1990 and 2022 for inclusion. Reference lists of relevant articles were hand searched. STUDY SELECTION Studies were independently screened by 2 authors and included if the implementation intervention targeted allied health clinical practice in any stroke rehabilitation context and reported at least 1 quantitative measure of evidence uptake. Thirty studies met inclusion criteria. DATA EXTRACTION Data were independently extracted by the first and second author. Implementation outcomes for each study were categorized as either mostly successful, partially successful, or not successful based on the degree of evidence uptake achieved. Determinants targeted were categorized using the Consolidated Framework for Implementation Research (CFIR). DATA SYNTHESIS Patterns between the degree of evidence uptake and determinants targeted across studies were analyzed by the first and second authors in 1 of 3 groups: A (pre-post statistical analysis), B (pre-post descriptive analysis), or C (post-only descriptive analysis). Patterns between evidence uptake and determinants targeted were first identified within groups A and B, with group C consulted to support findings. All studies categorized as "mostly successful" targeted facilitation in combination with establishing face-to-face networks and communication strategies. Conversely, no studies rated "not successful" targeted either of these determinants. Studies rated "partially successful" targeted either 1, but seldom both, of these determinants. CONCLUSIONS This review has provided descriptive evidence of determinants which may be important to target for allied health clinicians' uptake of evidence within stroke rehabilitation settings.
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Affiliation(s)
- Rachel Levine
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia.
| | - Sally Zingelman
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Marie-Pier McSween
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Kirstine Shrubsole
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia; Faculty of Health, Southern Cross University, Bilinga, Queensland Australia
| | - Annie Jane Hill
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
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Bland MD, Moore JL, Anderl E, Eikenberry M, McCarthy A, Olivier GN, Rice T, Siles A, Zeleznik H, Romney W. Knowledge Translation Task Force for core measures clinical practice guideline: a short report on the process and utilization. Implement Sci Commun 2024; 5:43. [PMID: 38641675 PMCID: PMC11027410 DOI: 10.1186/s43058-024-00580-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/05/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND As part of the 2018 Clinical Practice Guideline (CPG): A Core Set of Outcome Measures for Adults with Neurologic Conditions Undergoing Rehabilitation, a Knowledge Translation (KT) Task Force was convened. The purpose of this short report was to (1) demonstrate the potential impact of a CPG KT Task Force through a practical example of efforts to implement a CPG into neurologic physical therapy practice and (2) describe the process to convene a KT Task Force and develop products (KT Toolkit) to facilitate implementation of the CPG. METHODS To describe the process used by the KT Task Force to develop and review a KT Toolkit for implementation of the CPG. RESULTS Utilizing the Knowledge-To-Action Cycle framework, eight tools were developed as part of the KT Toolkit and are available with open access to the public. Findings indicate that the Core Outcome Measures Homepage, which houses the KT Toolkit, has had greater than 70,000 views since its publication. CONCLUSIONS This short report serves as an example of the efforts made to implement a CPG into physical therapy practice. The processes to facilitate KT and the tools developed can inform future implementation efforts and underscore the importance of having a KT Task Force to implement a CPG. Moving forward, KT Task Forces should be convened to implement new or revised guidelines. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Marghuretta D Bland
- Physical Therapy, Neurology, & Occupational Therapy, Program in Physical Therapy, Washington University, St. Louis, MO, USA.
| | - Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN, USA
- Regional Center for Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | | | - Megan Eikenberry
- College of Health Sciences, Physical Therapy Program, Midwestern University, Glendale, AZ, USA
| | - Arlene McCarthy
- PT, MS, DPT, Board Certified in Neurologic Physical Therapy, Former Program Director of Neurologic Physical Therapy Residency, Rehabilitation Services, Kaiser Permanente, San Francisco, CA, USA
| | - Geneviève N Olivier
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Tracy Rice
- Department of Human Performance, Division of Physical Therapy, West Virginia University, Morgantown, WV, USA
| | - Amelia Siles
- School of Health and Rehabilitation Services, Physical Therapy Division, The Ohio State University, Columbus, OH, USA
| | - Hallie Zeleznik
- Strategic Initiatives and Professional Development, UPMC Centers for Rehab Services Pittsburgh, Pittsburgh, PA, USA
| | - Wendy Romney
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
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Dos Santos RB, Fiedler A, Badwal A, Legasto-Mulvale JM, Sibley KM, Olaleye OA, Diermayr G, Salbach NM. Standardized tools for assessing balance and mobility in stroke clinical practice guidelines worldwide: A scoping review. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1084085. [PMID: 36896249 PMCID: PMC9989207 DOI: 10.3389/fresc.2023.1084085] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Background Use of standardized tools to assess balance and mobility limitations is a recommended practice in stroke rehabilitation. The extent to which clinical practice guidelines (CPGs) for stroke rehabilitation recommend specific tools and provide resources to support their implementation is unknown. Purpose To identify and describe standardized, performance-based tools for assessing balance and/or mobility and describe postural control components challenged, the approach used to select tools, and resources provided for clinical implementation, in CPGs for stroke. Methods A scoping review was conducted. We included CPGs with recommendations on the delivery of stroke rehabilitation to address balance and mobility limitations. We searched seven electronic databases and grey literature. Pairs of reviewers reviewed abstracts and full texts in duplicate. We abstracted data about CPGs, standardized assessment tools, the approach for tool selection, and resources. Experts identified postural control components challenged by each tool. Results Of the 19 CPGs included in the review, 7 (37%) and 12 (63%) were from middle- and high-income countries, respectively. Ten CPGs (53%) recommended or suggested 27 unique tools. Across 10 CPGs, the most commonly cited tools were the Berg Balance Scale (BBS) (90%), 6-Minute Walk Test (6MWT) (80%), Timed Up and Go Test (80%) and 10-Meter Walk Test (70%). The tool most frequently cited in middle- and high-income countries was the BBS (3/3 CPGs), and 6MWT (7/7 CPGs), respectively. Across 27 tools, the three components of postural control most frequently challenged were underlying motor systems (100%), anticipatory postural control (96%), and dynamic stability (85%). Five CPGs provided information in varying detail on how tools were selected; only 1 CPG provided a level of recommendation. Seven CPGs provided resources to support clinical implementation; one CPG from a middle-income country included a resource available in a CPG from a high-income country. Conclusion CPGs for stroke rehabilitation do not consistently provide recommendations for standardized tools to assess balance and mobility or resources to facilitate clinical application. Reporting of processes for tool selection and recommendation is inadequate. Review findings can be used to inform global efforts to develop and translate recommendations and resources for using standardized tools to assess balance and mobility post-stroke. Systematic Review Registration https://osf.io/, identifier: 10.17605/OSF.IO/6RBDV.
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Affiliation(s)
- Renato B Dos Santos
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo - UNICID, Sao Paulo, Brazil.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Annabelle Fiedler
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Anchal Badwal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Jean Michelle Legasto-Mulvale
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gudrun Diermayr
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, University Health Network, Toronto, ON, Canada
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Salbach NM, MacKay-Lyons M, Howe JA, McDonald A, Solomon P, Bayley MT, McEwen S, Nelson M, Bulmer B, Lovasi GS. Assessment of Walking Speed and Distance Post-Stroke Increases After Providing a Theory-Based Toolkit. J Neurol Phys Ther 2022; 46:251-259. [PMID: 35671402 PMCID: PMC9462135 DOI: 10.1097/npt.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE While underutilized, poststroke administration of the 10-m walk test (10mWT) and 6-minute walk test (6MWT) can improve care and is considered best practice. We aimed to evaluate provision of a toolkit designed to increase use of these tests by physical therapists (PTs). METHODS In a before-and-after study, 54 PTs and professional leaders in 9 hospitals were provided a toolkit and access to a clinical expert over a 5-month period. The toolkit comprised a guide, smartphone app, and video, and described how to set up walkways, implement learning sessions, administer walk tests, and interpret and apply test results clinically. The proportion of hospital visits for which each walk test score was documented at least once (based on abstracted health records of ambulatory patients) were compared over 8-month periods pre- and post-intervention using generalized mixed models. RESULTS Data from 347 and 375 pre- and postintervention hospital visits, respectively, were analyzed. Compared with preintervention, the odds of implementing the 10mWT were 12 times greater (odds ratio [OR] = 12.4, 95% confidence interval [CI] 5.8, 26.3), and of implementing the 6MWT were approximately 4 times greater (OR = 3.9, 95% CI 2.3, 6.7), post-intervention, after adjusting for hospital setting, ambulation ability, presence of aphasia and cognitive impairment, and provider-level clustering. Unadjusted change in the percentage of visits for which the 10mWT/6MWT was documented at least once was smallest in acute care settings (2.0/3.8%), and largest in inpatient and outpatient rehabilitation settings (28.0/19.9% and 29.4/23.4%, respectively). DISCUSSION AND CONCLUSIONS Providing a comprehensive toolkit to hospitals with professional leaders likely contributed to increasing 10mWT and 6MWT administration during inpatient and outpatient stroke rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A390 ).
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Affiliation(s)
- Nancy M. Salbach
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Marilyn MacKay-Lyons
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Jo-Anne Howe
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Alison McDonald
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Patricia Solomon
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Mark T. Bayley
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Sara McEwen
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Michelle Nelson
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Beverly Bulmer
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Gina S. Lovasi
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
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