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Fulton S, Janssen H, Salih S, James A, Elphinston RA. Feasibility and acceptability of a mobile model of environmental enrichment for patients with mixed medical conditions receiving inpatient rehabilitation: a mixed methods study. BMJ Open 2022; 12:e061212. [PMID: 36115676 PMCID: PMC9486324 DOI: 10.1136/bmjopen-2022-061212] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the feasibility and acceptability of a mobile model of environmental enrichment (EE), a paradigm that promotes activity engagement after stroke, in patients with mixed medical conditions receiving inpatient rehabilitation. DESIGN A mixed methods study design was used. An online qualitative survey assessed staff perspectives of acceptability of the mobile EE model including perceived barriers and enablers pre-implementation and post implementation. An A-B quasi-experimental case study of patient activity levels over a 2-week observational period provided feasibility data. This included recruitment and retention rates, completion of scheduled patient activity observations and validated baseline questionnaires, and number of adverse events. SETTING A 30-bed mixed medical ward in a public hospital that services Brisbane's southern bayside suburbs. The rehabilitation programme operates with patients co-located throughout the medical/surgical wards. PARTICIPANTS Nursing and allied health professionals working across the rehabilitation programme completed pre-implementation (n=19) and post implementation (n=16) qualitative questions. Patients admitted to the ward and who received the inpatient rehabilitation programme from June to November 2016 were also recruited. INTERVENTIONS The mobile EE intervention included activities to primarily promote social and cognitive stimulation (eg, puzzles, board games) delivered by hospital volunteers and was designed to be moved throughout the wards. RESULTS Four themes emerged from staff reports, suggesting that the role of patient, staff and intervention characteristics, and the ward environment were important barriers and enablers to implementation. Of the 12 eligible patients, six consented to the study, and five completed the intervention. All patients completed the baseline measures. No adverse events were reported. CONCLUSIONS As interest grows in human EE models, it will be important to tailor EE interventions to the unique demands of hospital rehabilitation services. A mobile EE model delivered in a small, mixed rehabilitation ward appears feasible and acceptable to study in a larger controlled feasibility trial.
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Affiliation(s)
- Sarah Fulton
- Speech Pathology Department, Redland Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Heidi Janssen
- Hunter Stroke Service and Community and Aged Care Services, Community Stroke Team, Hunter New England Local Health District and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Salih Salih
- Rehabilitation Unit, Redland Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Alecia James
- Speech Pathology Department, Redland Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Rachel A Elphinston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- National Health and Medical Research Council Centre of Research Excellence - Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Queensland, Australia
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Allen KAM, Dittmann KR, Hutter JA, Chuang C, Donald ML, Enns AL, Hovanec N, Hunt AW, Kellowan RS, Linkewich EA, Patel AS, Rehmtulla A, McEwen SE. Implementing a shared decision-making and cognitive strategy-based intervention: Knowledge user perspectives and recommendations. J Eval Clin Pract 2020; 26:575-581. [PMID: 31828869 DOI: 10.1111/jep.13329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/04/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022]
Abstract
The aim of this study was to employ knowledge user perspectives to develop recommendations that facilitate implementation of a complex, shared decision-making (SDM)-based intervention in an interprofessional setting. This study was part of a larger knowledge translation (KT) study in which interprofessional teams from five freestanding, academically affiliated, rehabilitation hospitals were tasked with implementing a cognitive strategy-based intervention approach that incorporates SDM known as Cognitive Orientation to daily Occupational Performance (CO-OP) to treat survivors of stroke. At the end of the 4-month CO-OP KT implementation support period, 10 clinicians, two from each site, volunteered as CO-OP site champions. A semi-structured focus group was conducted with 10 site champions 3 months following the implementation support period. To meet the study objective, an exploratory qualitative research design was used. The focus group session was audio-recorded, transcribed verbatim and analyzed through the lens of the integrated promoting action on research implementation in health services (iPARIHS) framework. The focus group participants (n = 8) consisted of occupational therapists, physical therapists, and speech language pathologists. Ten recommendations for CO-OP implementation were extracted and co-constructed from the focus group transcript. The recommendations reflected all four iPARHIS constructs: Facilitation, Context, Innovation, and Recipients. Implementation recommendations, from the knowledge user perspective, highlight that context-specific facilitation is key to integrating a novel, complex intervention into interprofessional practice. Facilitators should lay out a framework for training, communication and implementation that is structured but still provides flexibility for iterative learning and active problem-solving within the relevant practice context.
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Affiliation(s)
- Kay-Ann M Allen
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Katherine R Dittmann
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jennifer A Hutter
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Kinesiology, McMaster University, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | - Michelle L Donald
- Health System Planning & Engagement, Central Local Health Integration Network, Toronto, ON, Canada
| | - Amie L Enns
- Neurological Rehabilitation Services, West Park Healthcare Centre, Toronto, ON, Canada
| | - Nina Hovanec
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Anne W Hunt
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Richard S Kellowan
- Bridgepoint Active Healthcare, Sinai Health System, Toronto, ON, Canada.,Stroke & Neuro Rehab, Providence Healthcare, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Elizabeth A Linkewich
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Alexandra S Patel
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | - Sara E McEwen
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Jolliffe L, Hoffmann T, Lannin NA. Increasing the uptake of stroke upper limb guideline recommendations with occupational therapists and physiotherapists. A qualitative study using the Theoretical Domains Framework. Aust Occup Ther J 2019; 66:603-616. [PMID: 31338859 DOI: 10.1111/1440-1630.12599] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/05/2019] [Accepted: 06/16/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite the availability of stroke clinical practice guidelines and acceptance by therapists that guidelines contain 'best practice' recommendations, compliance remains low. While previous studies have explored barriers associated with implementing rehabilitation guidelines in general, it remains unknown if these barriers are applicable to upper limb rehabilitation specifically. To plan effective implementation activities, key motivators and barriers to use should be identified. METHOD To investigate occupational and physiotherapists' perceptions of motivators and barriers to using upper limb clinical practice guideline recommendations in stroke rehabilitation, a mixed-method study was conducted. Using an online survey and semi-structured focus groups, physiotherapists and occupational therapists working in one of six stroke rehabilitation teams in Melbourne, Australia were invited to participate. Survey data were analysed using descriptive statistics, and thematic coding of free-text responses. Focus groups were transcribed, thematically coded and mapped against the Theoretical Domains Framework. RESULTS Forty-six participants completed the survey and 29 participated in the focus groups. Key motivators to use guideline recommendations included past experience with specific interventions, availability of required resources and an enabling workplace culture. Barriers included: limited training/skills in specific interventions, the complexity of intervention protocols, and beliefs about intervention effectiveness. Lack of accountability was highlighted and therapists perceived they are rarely checked for quality assurance purposes regarding guideline adherence. CONCLUSION Therapists identified that both motivators and barriers to implementing best-practice upper limb rehabilitation occur largely at the levels of the individual and the environment. As such, intervention efforts should focus at both these levels to facilitate change.
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Affiliation(s)
- Laura Jolliffe
- School of Allied Health (Occupational Therapy), College of Science, Health & Engineering, La Trobe University, Melbourne, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Natasha A Lannin
- School of Allied Health (Occupational Therapy), College of Science, Health & Engineering, La Trobe University, Melbourne, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Australia
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McEwen SE, Donald M, Jutzi K, Allen KA, Avery L, Dawson DR, Egan M, Dittmann K, Hunt A, Hutter J, Quant S, Rios J, Linkewich E. Implementing a function-based cognitive strategy intervention within inter-professional stroke rehabilitation teams: Changes in provider knowledge, self-efficacy and practice. PLoS One 2019; 14:e0212988. [PMID: 30856191 PMCID: PMC6411258 DOI: 10.1371/journal.pone.0212988] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/13/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The Cognitive Orientation to daily Occupational Performance (CO-OP) approach is a complex rehabilitation intervention in which clients are taught to use problem-solving cognitive strategies to acquire personally-meaningful functional skills, and health care providers are required to shift control regarding treatment goals and intervention strategies to their clients. A multi-faceted, supported, knowledge translation (KT) initiative was targeted at the implementation of CO-OP in inpatient stroke rehabilitation teams at five freestanding rehabilitation hospitals. The study objective was to estimate changes in rehabilitation clinicians' knowledge, self-efficacy, and practice related to implementing CO-OP. METHODS A single arm pre-post and 6-month follow up study was conducted. CO-OP KT consisted of a 2-day workshop, 4 months of implementation support, a consolidation session, and infrastructure support. In addition, a sustainability plan was implemented. Consistent with CO-OP principles, teams were given control over specific implementation goals and strategies. Multiple choice questions (MCQ) were used to assess knowledge. A self-efficacy questionnaire with 3 subscales (Promoting Cognitive Strategy Use, PCSU; Client-Focused Therapy, CFT; Top-Down Assessment and Treatment, TDAT) was developed for the study. Medical record audits were used to investigate practice change. Data analysis for knowledge and self-efficacy utilized mixed effects models. Medical record audits were analyzed with frequency counts and chi-squares. RESULTS Sixty-five health care providers consisting mainly of occupational and physical therapists entered the study. Mixed effects models revealed intervention effects for MCQs, CFT, and PCSU at post intervention and follow-up, but no effect on TDAT. No charts showed any evidence of CO-OP use at baseline, compared to 8/40 (20%) post intervention. Post intervention there was a trend towards reduction in impairment goals and significantly more component goals were set (z = 2.7, p = .007).
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Affiliation(s)
- Sara E. McEwen
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Donald
- North & East GTA Stroke Network, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Katelyn Jutzi
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Kay-Ann Allen
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Lisa Avery
- Avery Information Services Ltd., Orillia, Ontario, Canada
| | - Deirdre R. Dawson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department & Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | - Mary Egan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Katherine Dittmann
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Anne Hunt
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department & Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Jennifer Hutter
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Sylvia Quant
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- North & East GTA Stroke Network, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jorge Rios
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Elizabeth Linkewich
- North & East GTA Stroke Network, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department & Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Practice-Based Research, Sunnybrook Research Institute, Toronto, Ontario, Canada
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