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Tierney-Hendricks C, Schliep ME, Sun M, Gochyyev P, Carter C. Using the RE-AIM and TDF frameworks to evaluate the implementation of a standardized cognitive assessment protocol in outpatient rehabilitation. PM R 2024. [PMID: 39158202 DOI: 10.1002/pmrj.13250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Impairments in cognition significantly affect patient functioning and rehabilitation outcomes. Assessment is essential to identifying at-risk individuals and guiding care plans. OBJECTIVE A cognitive assessment protocol was implemented in occupational therapy (OT) and speech-language pathology (SLP) outpatient practice. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and Theoretical Domains Framework (TDF), this study (1) measured the reach and adoption of the cognitive assessment protocol and (2) explored determinants and strategies that may affect adoption. DESIGN Sequential mixed methods. SETTING Two outpatient rehabilitation clinics (A and B) within a health care network. PARTICIPANTS Medical records from 220 adult patients with neurologic diagnosis and 15 OT and SLP clinicians. INTERVENTIONS Cognitive assessment protocol. MAIN OUTCOME MEASURE(S) Reach of the assessment protocol across patient characteristics and adoption across clinical sites were measured quantitatively via retrospective electronic medical records review. Qualitative data on effectiveness and the implementation process were collected via clinician focus groups. RESULTS Protocol adoption rates were 71% and 54% at clinics A and B, respectively. Site B OT was more likely to be noncompliant with protocol adoption compared to Site A, when controlling for patient characteristics, (81% vs. 16%, respectively; odds ratio = 11.4, 95% confidence interval [3.36-38.64], p ≤ .001). Patient age was a significant factor for protocol reach; older age was associated with noncompliance of the SLP protocol adoption, p < .05. Both sites employed implementation strategies targeting the provider level (eg, education/training); Site A additionally included organization-level strategies (eg, leadership engagement). In the absence of organization-level strategies, OT and SLP clinicians at Site B identified barriers related to leadership support, resources, and workflow. CONCLUSIONS Standardized practice protocols are feasible to implement within the rehabilitation setting, though multilevel implementation strategies may be needed to promote adoption. Aligning practices with the needs, values and priorities of the organization, providers, and patients and families is imperative.
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Affiliation(s)
| | - Megan E Schliep
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Minsi Sun
- MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Perman Gochyyev
- MGH Institute of Health Professions, Boston, Massachusetts, USA
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Rubi-Fessen I, Gerbershagen K, Stenneken P, Willmes K. Early Boost of Linguistic Skills? Individualized Non-Invasive Brain Stimulation in Early Postacute Aphasia. Brain Sci 2024; 14:789. [PMID: 39199482 PMCID: PMC11353206 DOI: 10.3390/brainsci14080789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 09/01/2024] Open
Abstract
Non-invasive brain stimulation, such as transcranial direct current stimulation (tDCS), has been shown to increase the outcome of speech and language therapy (SLT) in chronic aphasia. Only a few studies have investigated the effect of add-on tDCS on SLT in the early stage of aphasia; this may be due to methodological reasons, in particular the influence of spontaneous remission and the difficulty of establishing stimulation protocols in clinical routines. Thirty-seven participants with subacute aphasia (PwA) after stroke (23 men, 14 women; mean age 62 ± 12 years; mean duration 49 ± 28 days) were included in two consecutive periods of treatment lasting two weeks each. During the first period (P1) the participants received 10 sessions of SLT, during the second period (P2) the aphasia therapy was supplemented by anodal left hemispheric 2 mA tDCS over the left hemisphere. Severity-specific language tests (Aachen Aphasia Test (AAT), n = 27 and Bielefeld Aphasia Screening-Reha (BIAS-R), n = 10) were administered before P1, between P1 and P2, and after P2. Where information was available, the results were corrected for spontaneous remission (AAT sample), and the therapy outcomes of P1 and P2 were compared. Participants' overall language abilities improved significantly during P1 and P2. However, improvement-as measured by the AAT profile level or the BIAS-R mean percentage value-during P2 (with tDCS) was significantly higher than during P1 (p < 0.001; AAT sample and p = 0.005; BIAS-R sample). Thus, tDCS protocols can be implemented in early aphasia rehabilitation. Despite the limitations of the research design, which are also discussed from an implementation science perspective, this is preliminary evidence that an individually tailored anodal tDCS can have a significant add-on effect on the outcome of behavioral aphasia therapy in subacute aphasia.
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Affiliation(s)
- Ilona Rubi-Fessen
- Neurological Rehabilitation Hospital, RehaNova Köln, 51109 Cologne, Germany;
- Department of Rehabilitation and Special Education, Faculty of Human Sciences, University of Cologne, 50931 Cologne, Germany;
| | | | - Prisca Stenneken
- Department of Rehabilitation and Special Education, Faculty of Human Sciences, University of Cologne, 50931 Cologne, Germany;
| | - Klaus Willmes
- Department of Neurology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
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Annaswamy TM, Grover P, Douglas NF, Poploski KM, Anderson CA, Clark MA, Flores AM, Hafner BJ, Hoffman JM, Kinney AR, Ressel K, Sánchez J, Whitten MJ, Resnik L, McDonough CM. Relevance of learning health systems to physiatrists and its synergy with implementation science: A commentary. PM R 2024. [PMID: 38967539 DOI: 10.1002/pmrj.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 01/17/2024] [Accepted: 02/25/2024] [Indexed: 07/06/2024]
Abstract
As health care attempts to bridge the gap between evidence and practice, the concept of the learning health system (LHS) is becoming increasingly relevant. LHS integrates evidence with health systems data, driving health care quality and outcomes through updates in policy, practice, and care delivery. In addition, LHS research is becoming critically important as there are several initiatives underway to increase research capacity, expertise, and implementation, including attempts to stimulate increasing numbers of LHS researchers. Physical Medicine & Rehabilitation (PM&R) physicians (physiatrists), nurses, therapists (physical therapists, occupational therapists, speech therapists, clinical psychologists), and scientists are affiliated with LHSs. As LHS research expands in health care systems, better awareness and understanding of LHSs and LHS research competencies are key for rehabilitation professionals including physiatrists. To address this need, the Agency of Healthcare Research and Quality (AHRQ) identified 33 core competencies, grouped into eight domains, for training LHS researchers. The domains are: (1) Systems Science; (2) Research Questions and Standards of Scientific Evidence; (3) Research Methods; (4) Informatics; (5) Ethics of Research and Implementation in Health Systems; (6) Improvement and Implementation Science; (7) Engagement, Leadership, and Research Management; and the recently added (8) Health and Healthcare Equity and Justice. The purpose of this commentary is to define LHS and its relevance to physiatrists, present the role of implementation science (IS) in LHSs and application of IS principles to design LHSs, illustrate current LHS research in rehabilitation, and discuss potential solutions to improve awareness and to stimulate interest in LHS research and IS among physiatrists in LHSs.
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Affiliation(s)
- Thiru M Annaswamy
- Department of Physical Medicine & Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Prateek Grover
- Department of Physical Medicine & Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Natalie F Douglas
- Department of Communication Sciences and Disorders, The Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Kathleen M Poploski
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catherine A Anderson
- Department of Counseling, Rehabilitation and Human Services, College of Education, Hospitality, Health and Human Sciences, University of Wisconsin, Stout, Wisconsin, USA
| | - Melissa A Clark
- Departments of Health Services Policy and Practice and Obstetrics and Gynecology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Ann Marie Flores
- Departments of Physical Therapy and Human Movement Sciences and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Adam R Kinney
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Kristin Ressel
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer Sánchez
- Department of Counselor Education, College of Education, Florida Atlantic University, Boca Raton, Florida, USA
| | - Margarite J Whitten
- Departments of Health Services Policy and Practice and Obstetrics and Gynecology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Linda Resnik
- Departments of Health Services Policy and Practice and Obstetrics and Gynecology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Christine M McDonough
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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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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Barbosa PM, Szrek H, Ferreira LN, Cruz VT, Firmino-Machado J. Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individuals. Ann Phys Rehabil Med 2024; 67:101824. [PMID: 38518399 DOI: 10.1016/j.rehab.2024.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Stroke burden challenges global health, and social and economic policies. Although stroke recovery encompasses a wide range of care, including in-hospital, outpatient, and community-based rehabilitation, there are no published cost-effectiveness studies of integrated post-stroke pathways. OBJECTIVE To determine the most cost-effective rehabilitation pathway during the first 12 months after a first-ever stroke. METHODS A cohort of people in the acute phase of a first stroke was followed after hospital discharge; 51 % women, mean (SD) age 74.4 (12.9) years, mean National Institute of Health Stroke Scale score 11.7 (8.5) points, and mode modified Rankin Scale score 3 points. We developed a decision tree model of 9 sequences of rehabilitation care organised in 3 stages (3, 6 and 12 months) through a combination of public, semi-public and private entities, considering both the individual and healthcare service perspectives. Health outcomes were expressed as quality-adjusted life years (QALY) over a 1-year time horizon. Costs included healthcare, social care, and productivity losses. Sensitivity analyses were conducted on model input values. RESULTS From the individual perspective, pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective, followed by pathway 1 (Rehabilitation Centre » Community Clinic). From the healthcare service perspective, pathway 3 was the most cost-effective followed by pathway 7 (Outpatient Hospital » Private Clinic). All other pathways were considered strongly dominated and excluded from the analysis. The total 1-year mean cost ranged between €12104 and €23024 from the individual's perspective and between €10992 and €31319 from the healthcare service perspective. CONCLUSION Assuming a willingness-to-pay threshold of one times the national gross domestic product (€20633/QALY), pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective strategy from both the individual and healthcare service perspectives. Rehabilitation pathway data contribute to the development of a future integrated care system adapted to different stroke profiles.
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Affiliation(s)
- Pedro Maciel Barbosa
- Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Rua de Alfredo Cunha 365, 4450-021 Matosinhos, Portugal; Centro de Investigação em Reabilitação, Escola Superior de Saúde, Instituto Politécnico do Porto, R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
| | - Helena Szrek
- Centre for Economics and Finance, University of Porto, R. Dr. Roberto Frias, 4200-464 Porto, Portugal
| | - Lara Noronha Ferreira
- ESGHT, Universidade do Algarve, Estr. da Penha 139, 8005-246 Faro, Portugal; Centre for Health Studies and Research of the University of Coimbra, Avenida Dias da Silva 165, 3004-512 Coimbra, Portugal; Research Centre for Tourism, Sustainability and Well-Being (CinTurs), Portugal.
| | - Vitor Tedim Cruz
- Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Rua de Alfredo Cunha 365, 4450-021 Matosinhos, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal
| | - João Firmino-Machado
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; Centro Académico Clínico Egas Moniz, 810-193 Aveiro, Portugal; Centro Hospitalar Vila Nova de Gaia/Espinho, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
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Brycke S, Bråndal A, Brogårdh C. Implementation of evidence-based interventions according to the Swedish National Guidelines for Strokecare: a nationwide survey among physiotherapists. J Rehabil Med 2024; 56:jrm18444. [PMID: 38501731 DOI: 10.2340/jrm.v56.18444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To investigate (i) to what extent physiotherapists (PTs) working in stroke rehabilitation in various parts of the stroke care chain have implemented interventions according to the national guidelines for stroke (NGS), (ii) facilitating and hindering factors for the implementation, and (iii) differences between various care settings. DESIGN A cross-sectional study. SUBJECTS 148 PTs working in stroke rehabilitation in various parts of the care chain in Sweden. METHODS Data were collected by a web-based survey. RESULTS Task-specific training for walking (80-98%), impaired motor function (64-100%) and fall prevention (73-92%) were most implemented. Factors that facilitated implementation were: important to comply with the NGS, that PTs had confidence to perform the interventions, and that interventions were clearly described. Limited time, lack of resources, no clear goals or routines at the workplace hindered the implementation. Significant differences (p < 0.05) between the settings existed. Municipal and primary care reported most challenges in implementing the NGS and providing evidence-based interventions. CONCLUSION Most interventions, with high priority according to NGS, are provided by PTs working in stroke rehabilitation, although differences in various parts of the care chain exist. Knowledge, time, education and supportive management are important factors when implementing evidence-based interventions.
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Affiliation(s)
- Sara Brycke
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden
| | - Anna Bråndal
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Christina Brogårdh
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden; Department of Health Sciences, Lund University, Lund, Sweden.
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Donnelly MR, Marin-Pardo O, Abdullah A, Phanord C, Kumar A, Chakraborty S, Liew SL. Pre-Implementation Analysis of the Usability and Acceptability of a Poststroke Complex Telehealth Biofeedback Intervention. Am J Occup Ther 2024; 78:7802180210. [PMID: 38407976 PMCID: PMC11017739 DOI: 10.5014/ajot.2024.050501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
IMPORTANCE Complex telehealth interventions can facilitate remote occupational therapy services and improve access for people living with chronic neurological conditions. Understanding the factors that influence the uptake of these technologies is important. OBJECTIVE To explore the fit between electromyography (EMG) biofeedback and telerehabilitation for stroke survivors, optimize EMG biofeedback interventions, and, more broadly, support other efforts to develop complex telerehabilitation interventions. DESIGN Pre-implementation mixed-methods analysis of usability and acceptability data collected during a pilot and feasibility study. SETTING Community. PARTICIPANTS Adult stroke survivors with hemiparesis (N = 11; M age = 54 yr). INTERVENTION Game-based EMG biofeedback system for arm sensorimotor rehabilitation, delivered via telehealth. OUTCOMES AND MEASURES Post-Study System Usability Questionnaire, an extended Unified Theory of Acceptance and Use of Technology model questionnaire, and semistructured interview. We coded the interview data using questionnaire constructs. RESULTS Participants used an EMG biofeedback intervention at home. Quantitative measures show high levels of perceived usability and acceptability, supported by qualitative findings describing specific facilitators and barriers. CONCLUSIONS AND RELEVANCE Pre-implementation studies can improve the design and relevance of complex telehealth interventions. One major conclusion from this study is the influence of therapy providers on acceptability and usability of complex telehealth interventions. Plain-Language Summary: This study contributes to an emerging body of literature that examines the use of complex telehealth interventions with survivors of neurological injury. The findings highlight the value and support the development and use of complex telehealth interventions, which have the potential to improve remote access to occupational therapy for clients living with chronic neurological conditions. Complex telehealth interventions can open doors for survivors of neurological injury who face barriers to accessing occupational therapy and would benefit from technology-enabled therapy at home.
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Affiliation(s)
- Miranda Rennie Donnelly
- Miranda Rennie Donnelly, MS, OTR/L, is PhD Candidate, Chan Division of Occupational Science & Occupational Therapy, University of Southern California, Los Angeles;
| | - Octavio Marin-Pardo
- Octavio Marin-Pardo, PhD, is Postdoctoral Researcher, Chan Division of Occupational Science & Occupational Therapy, University of Southern California, Los Angeles
| | - Aisha Abdullah
- Aisha Abdullah, MA, OTR/L, is OTD Resident, Chan Division of Occupational Science & Occupational Therapy, University of Southern California, Los Angeles
| | - Coralie Phanord
- Coralie Phanord, BA, BE, is Graduate Student, Clinical Psychology, University of Colorado Boulder. At the time of this study, Phanord was Programmer Analyst, Chan Division of Occupational Science & Occupational Therapy, University of Southern California, Los Angeles
| | - Amisha Kumar
- Amisha Kumar is Undergraduate Research Assistant, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles
| | - Stuti Chakraborty
- Stuti Chakraborty, BOT, is PhD Student, Chan Division of Occupational Science & Occupational Therapy, University of Southern California, Los Angeles
| | - Sook-Lei Liew
- Sook-Lei Liew, PhD, OTR/L, is Associate Professor, Chan Division of Occupational Science & Occupational Therapy, University of Southern California, Los Angeles;
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Rose Sin Yi L, Jing Jing S, Hammoda AO, Jonathan B, Ladislav B, Jing Q. Effects of virtual reality-based cognitive interventions on cognitive function and activity of daily living among stroke patients: Systematic review and meta-analysis. J Clin Nurs 2024; 33:1169-1184. [PMID: 38234275 DOI: 10.1111/jocn.16986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/24/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024]
Abstract
AIMS To examine the effects of virtual reality-based cognitive interventions on cognitive function and activities of daily living among stroke patients, and to identify the optimal design for such intervention. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, EMBASE, Cochrane, CINANL, JBI-EBP and Web of Science from inception to October 2023. METHODS Methodological quality was assessed by Risk of Bias Tool. Meta-analyses were assessed by Review Manager 5.4. Subgroup analyses were conducted to explore the influence of study design. Grading of Recommendations Assessment, Development and Evaluation approach was adopted to assess the certainty of evidence. RESULTS Twenty-five randomized controlled trials (1178 participants) were included. Virtual reality-based cognitive interventions demonstrated moderate-to-large effects in improving global cognitive function (SMD = 0.43; 95% CI [0.01, 0.85]), executive function (SMD = 0.84; 95% CI [0.25, 1.43]) and memory (SMD = 0.65; 95% CI [0.15, 1.16]) compared to control treatments. No significant effects were found on language, visuospatial ability and activities of daily living. Subgroup analyses indicated one-on-one coaching, individualized design and dynamic difficulty adjustment, and interventions lasting ≥ 6 weeks had particularly enhanced effects, especially for executive function. CONCLUSIONS Virtual reality-based cognitive interventions improve global cognitive function, executive function and memory among stroke patients. IMPLICATIONS FOR THE PATIENT CARE This review underscores the broad cognitive advantages offered by virtual technology, suggesting its potential integration into standard stroke rehabilitation protocols for enhanced cognitive recovery. IMPACT The study identifies key factors in virtual technology interventions that effectively improve cognitive function among stroke patients, offering healthcare providers a framework for leveraging such technology to optimize cognitive outcomes in stroke rehabilitation. REPORTING METHOD PRISMA 2020 statement. PROSPERO REGISTRATION NUMBER CRD42022342668.
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Affiliation(s)
- Lin Rose Sin Yi
- School of Nursing, Elaine C. Hubbard Center for Nursing Research on Aging, University of Rochester, Rochester, New York, USA
| | - Su Jing Jing
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Abu-Odah Hammoda
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Bayuo Jonathan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Batalik Ladislav
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Qin Jing
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Bar-Nizan T, Rand D, Lahav Y. Implementation of Evidence-Based Practice and Burnout Among Occupational Therapists: The Role of Self-Efficacy. Am J Occup Ther 2024; 78:7801205190. [PMID: 38175805 DOI: 10.5014/ajot.2024.050426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
IMPORTANCE Implementing evidence-based practice (EBP) is essential for ensuring optimal quality care and obtaining positive outcome in treatment. Occupational therapists generally hold positive attitudes toward EBP; however, EBP is not always fully implemented. OBJECTIVE To explore the mediating role of self-efficacy on the relationship between implementing EBP and burnout among occupational therapists. DESIGN A cross sectional study. SETTING Data were collected through social media and WhatsApp groups using an online survey accessible through Qualtrics, a secured web-based data collection system; responses were anonymous. PARTICIPANTS The final sample consisted of 261 female Israeli occupational therapists (ages 24-65 yr, with 1-40 yr of clinical experience). OUTCOMES AND MEASURES The following questionnaires assessed EBP implementation, burnout, and self-efficacy, respectively: the EBP Implementation Scale, the Maslach Burnout Inventory, and the Occupational Therapy Self-Efficacy Questionnaire. Demographic data were also collected. RESULTS EBP implementation was low (0-43 points out of a maximum 72 points), moderate levels of burnout and high levels of self-efficacy were reported. Significant associations with medium effect sizes were found between EBP implementation and burnout: the higher the levels of EBP implementation, the lower the levels of burnout frequency and intensity. Moreover, self-efficacy mediated these relationships. EBP implementation was related to elevated self-efficacy, which, in turn, was associated with lower burnout. CONCLUSIONS AND RELEVANCE EBP implementation may serve as an important tool to limit burnout among occupational therapists by fostering their trust in their ability to handle clinical challenges. Further research is needed. Plain-Language Summary: This study explored implementing evidence-based practice (EBP) and its relationships to burnout and work-related self-efficacy among occupational therapists. The study found that self-efficacy mediated the relationships between implementing EBP and burnout. Implementing EBP was associated with higher self-efficacy, which, in turn, was associated with lower burnout among occupational therapists.
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Affiliation(s)
- Tal Bar-Nizan
- Tal Bar-Nizan, MSc, OT, is Occupational Therapist, Department of Occupational Therapy, The Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. At the time of the research, Bar-Nizan was Graduate Student, Department of Occupational Therapy, The Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Debbie Rand
- Debbie Rand, PhD, OT, is Associate Professor, Department of Occupational Therapy, The Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lahav
- Yael Lahav, PhD, is Clinical Psychologist, Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
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Subramaniam S, Wang S, Bhatt T. Effect of a customized safety harness on movement kinematics in a dance-based exergaming among people with chronic stroke. Clin Biomech (Bristol, Avon) 2024; 111:106139. [PMID: 38039953 DOI: 10.1016/j.clinbiomech.2023.106139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Dance-based exergaming has exhibited efficacy in people with chronic stroke, it is beneficial to advance towards independent self-training to increase long-term compliance, and cost effectiveness through safety harness devices. Thus, the purpose of the study was to investigate people with chronic stroke's dance-movement kinematics to different types of assistance, namely no assistance, safety harness assistance, and contact guard assistance with gait belt. METHODS Community-dwelling people with chronic stroke (n = 10) participated in the study. Seven inertial sensors were used to capture their dance movements with three songs slow, medium, and fast pace. Three trials were recorded for each dance and the mean values of variables were used for analysis. A customized MATLAB code generated joint angle excursions (difference between the maximum and minimum angle peaks) of the hip, knee, and ankle in the sagittal plane. FINDINGS The results exhibited decreased joint angle excursions in no assistance condition in comparison to safety harness assistance and contact guard assistance conditions for all song paces (p < 0.05). The safety harness, and contact guard assistance condition exhibited similar levels of joint angle excursions for the all the conditions, except significantly higher hip (slow, and fast pace) (p < 0.05), and ankle (medium pace) (p < 0.05) joint angle excursions in contact guard assistance in comparison to safety harness assistance. INTERPRETATION The study represents the joint angle excursions that are influenced by different conditions in chronic stroke. Future studies, should evaluate feasibility of safety harness augmented dance-based exergaming in home-setting among chronic stroke.
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Affiliation(s)
- Savitha Subramaniam
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Shuaijie Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Pisegna J, Knebel R, Juckett L, Darragh A, Nichols-Larsen DS, Krok-Schoen JL. Occupational Therapy for Poststroke Anxiety and Depressive Symptoms in Inpatient Rehabilitation. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:78-87. [PMID: 36748712 DOI: 10.1177/15394492231151886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Poststroke anxiety and depressive symptoms (P-SADS) affect one in three people and are associated with decreased participation in activities of daily living. This study sought to characterize occupational therapy (OT) P-SADS care practices and identify factors influencing P-SADS care provision in one U.S. inpatient rehabilitation (IRF) facility. An explanatory sequential mixed-methods study design was used by gathering data from electronic health records (from January 1, 2019 to December 31, 2019) as well as semi-structured interviews with OT practitioners in the IRF. No objective P-SADS screens were documented nor were any P-SADS-focused goals written. Minimal evidence-based P-SADS interventions were identified. Practitioners reported multi-level barriers to OT P-SADS care including limited time, pressure to prioritize physical recovery, and inadequate resources to guide practice. OT practitioner P-SADS care was inconsistent with established evidence-based practice. This research identifies gaps in comprehensive stroke recovery and informs implementation efforts to support evidence-based P-SADS care in IRFs.
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Affiliation(s)
- Janell Pisegna
- University of Colorado Anschutz Medical Campus, Aurora, USA
- GRECC VA Eastern Colorado Health Care System, Aurora, USA
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12
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Tierney-Hendricks C, Schliep ME, Vallila-Rohter S. Barriers and facilitators to outcome measurement and treatment practices in aphasia rehabilitation in the USA: a mixed methods approach using the Theoretical Domains Framework. Disabil Rehabil 2023:1-16. [PMID: 38053357 DOI: 10.1080/09638288.2023.2288221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/22/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE To identify clinician-perceived barriers and facilitators to the delivery of outcome measurement and evidence-based treatment practices and integration of these practices in aphasia rehabilitation. MATERIALS AND METHODS Using a convergent mixed methods design, aphasia clinicians (n = 87) across care settings in the United States completed an online survey designed within the Theoretical Domains Framework (TDF). Participants responded to open-ended questions and rated Likert scale statements. Qualitative data were analyzed using content analysis and quantitative data were summarized using descriptive statistics. RESULTS Factors related to the TDF domain of "environmental context and resources" (priority and productivity demands; characteristics of resources) were cited as primary barriers in 70% of qualitative responses for both outcome and treatment practices and were consistent with Likert rating statements. Facilitators were associated with TDF domains of "memory, attention, decision-making" (decision-making processes), "knowledge" (awareness of evidence) and "social influences" (client and caregiver preferences). CONCLUSIONS Organizational-level factors and the misalignment of the research evidence with clinical needs are barriers to delivering evidence-based care in aphasia rehabilitation. Theoretically informed strategies such as establishing organizational infrastructure for practice change, developing clinically relevant evidence through research-practice partnerships, and implementing algorithms to support clinical decision-making can address barriers and leverage facilitators.
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Affiliation(s)
| | - Megan E Schliep
- Spaulding Rehabilitation Hospital, Boston, MA, USA
- MGH Institute of Health Professions, Boston, MA, USA
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Li X, Xing X, Yao N. Critical quality appraisal and algorithm development of clinical practice guidelines for management of poststroke sensory loss: a systematic review. BMJ Open 2023; 13:e074082. [PMID: 37977862 PMCID: PMC10660658 DOI: 10.1136/bmjopen-2023-074082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aimed to assess the methodological quality of clinical practice guidelines (CPGs) associated with the management of poststroke sensory loss and develop an algorithm for health professionals. METHODS We conducted a systematic review for relevant CPGs published between 2017 and 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist. Appraisal of Guidelines for Research and Evaluation II instrument was used to assess methodological quality. Recommendations for managing poststroke sensory loss from high and average-quality CPGs were summarised and developed into an algorithm. RESULTS First, 1458 records were identified from the database searches and other sources. Finally, four CPGs were included: three were rated as high quality and one as average quality. Twenty-two recommendations were summarised from these CPGs and used to develop a draft algorithm. Then, we revised the draft algorithm developed by the authors based on expert feedback to form the final version. CONCLUSIONS The four CPGs included in this study had good quality. Based on these CPGs, we developed an algorithm to facilitate health professionals' adherence to CPGs and contribute to evidence-based medicine. In the future, more high-quality CPGs are required to give further scientific and convincing evidence to manage poststroke sensory loss.
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Affiliation(s)
- Xiao Li
- Intensive Care Unit, Nanjing Drum Tower Hospital, Nanjing, China
| | - Xingmin Xing
- Intensive Care Unit, Nanjing Drum Tower Hospital, Nanjing, China
| | - Nannan Yao
- Operating Theatre, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
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14
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Hahn B, Fisher H, Hansen P, Kottorp A. Feasibility of Increasing Occupation-Based Assessment Using the Knowledge to Action Framework. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:645-654. [PMID: 36452986 DOI: 10.1177/15394492221137377] [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] [Indexed: 09/08/2023]
Abstract
The Assessment of Motor and Process Skills (AMPS) is a standardized occupation-based measure; however, barriers often limit use in practice. The Knowledge to Action Framework (KTA) is one of the most widely used implementation approaches to induce practice change. The objective of the study is to examine the feasibility and acceptability of a KTA-informed intervention to increase the use of the AMPS. AMPS-trained occupational therapists were recruited through convenience sampling. Interventions included workshops, action planning, goal setting, peer support, and organizational resources. Recruitment and retention were tracked. Pre- and post-survey results of interventions' helpfulness, AMPS behaviors, and motivational changes informed acceptability. Participants (n = 5) rated 7/7 (100%) intervention strategies as helpful, reported decreased barriers and increased frequency of AMPS administration, increased resources for AMPS implementation, and improved compatibility with practice. Implementation of a KTA-informed intervention to increase AMPS practice was feasible and supported by environmental changes and peer support in a physical rehabilitation setting.
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Affiliation(s)
- Bridget Hahn
- Rush University Medical Center, Chicago, IL, USA
| | | | - Piper Hansen
- Rush University Medical Center, Chicago, IL, USA
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15
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Brusco N, Morris ME, Foster S, Woods J, McCaskie D, Goodman S, Barnes C, Keren C, Frawley H. Improving stroke clinical guideline adherence in an Australian hospital using a clinician-led implementation process. Top Stroke Rehabil 2023; 30:738-750. [PMID: 36323526 DOI: 10.1080/10749357.2022.2141819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
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).
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Affiliation(s)
- Natasha Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Meg E Morris
- Healthscope ARCH, The Victorian Rehabilitation Centre, Glen Waverley, 3150, VIC, Australia
| | | | - Jeffrey Woods
- Healthscope ARCH, Melbourne, Victoria, Australia & College Science Health and Engineering, La Trobe University, Bundoora, 3086, VIC, Australia
| | - Doug McCaskie
- Associate Director of Allied Health, Alfred Health, Melbourne, VIC, Australia
| | | | | | | | - Helena Frawley
- School of Health Sciences, the University of Melbourne; Allied Health Research, Royal Women's Hospital, Melbourne and Mercy Hospital for Women, Melbourne, Victoria, Australia
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Maciel Barbosa P, Firmino-Machado J, Ferreira LN, Tedim Cruz V, Szrek H. From healthcare system to individuals through stroke rehabilitation pathways.Outcomes, information, and satisfaction along 12 months prospective cohort in Portugal. Top Stroke Rehabil 2023; 30:727-737. [PMID: 36651648 DOI: 10.1080/10749357.2023.2165266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The nature and quality of stroke survivor rehabilitation varies throughout Europe, including in Portugal, having not been widely monitored or benchmarked. OBJECTIVES This study analyses the stroke care pathway from three perspectives: healthcare system, process, and patient. METHODS The study uses data from a one-year single-center prospective cohort of first stroke patients, assessed at baseline, 3, 6, and 12 months. Care pathways and settings were described in terms of organizational model, funding, patient involvement, frequency and intensity and multidisciplinary team. Patient-level information and satisfaction were evaluated using a 10-point numeric rating scale. Kruskal - Wallis and post-hoc tests were used to compare EQ-5D-3 L, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Barthel Index, Mini-Mental State Examination scores between pathways and settings. RESULTS A total of 391 acute stroke patients, with a mean disability of 3.7 (mRS) and severity of 11.7 (NIHSS) participated. Six pathways and eight settings were described. A lack of compliance between guidelines and care was identified. There were significant differences in the four outcomes between the six pathways (p-values 0.007 to 0.020) suggesting inefficiency and inequalities, with an inadequate level of information and patient satisfaction. After post-hoc analysis, pathways 1 and 2 showed highest outcomes (p-values 0.001 to 0.002). Within settings, short-term units showed high scores, followed by rehabilitation center, outpatient hospital, and community clinic (p-values 0.001 to 0.040). CONCLUSION A multilevel characterization of the post-stroke rehabilitation pathway showed a more complete perspective on stroke management which may contribute to future rehabilitation and stroke policies.
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Affiliation(s)
- Pedro Maciel Barbosa
- Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Portugal
- Centro de Investigação em Reabilitação, Escola Superior de Saúde, Politécnico do Porto, Portugal
| | - João Firmino-Machado
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Centro Académico Clínico Egas Moniz, Aveiro, Portugal
- Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Lara Noronha Ferreira
- Universidade do Algarve - ESGHT, Portugal
- Centre for Health Studies and Research of the University of Coimbra/Centre for Innovative Biomedicine and Biotechnology, Portugal
- Research Centre for Tourism, Portugal
| | - Vitor Tedim Cruz
- Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Helena Szrek
- Centre for Economics and Finance, University of Porto, Porto, Portugal
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Johnson L, Mardo J, Demain S. Understanding implementation of a complex intervention in a stroke rehabilitation research trial: A qualitative evaluation using Normalisation Process Theory. PLoS One 2023; 18:e0282612. [PMID: 37682841 PMCID: PMC10490858 DOI: 10.1371/journal.pone.0282612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/18/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The Implicit Learning in Stroke study was a pilot cluster randomised controlled trial, investigating the use of different motor learning strategies in acute stroke rehabilitation. Participating Stroke Units (n = 8) were from the South East/West regions of the UK, with the experimental intervention (implicit learning) being delivered by clinical teams. It required therapists to change how they gave instructions and feedback to patients during rehabilitation. This paper reports the processes underpinning implementation of the implicit learning intervention. The evaluation aimed to i) understand how therapists made sense of, engaged with and interpreted the effects of the intervention; ii) compare this to the experience reported by patients; iii) extrapolate learning of broader relevance to the design and conduct of research involving complex interventions in stroke rehabilitation. METHODS Qualitative evaluation, with data collected through focus groups with clinical staff (n = 20) and semi structured interviews with people with stroke (n = 19). Mixed inductive and theory driven analysis, underpinned by Normalisation Process Theory. RESULTS How therapists made sense of and experienced the intervention impacted how it was implemented. The intervention was delivered by individual therapists, and was influenced by their individual values, beliefs and concerns. However, how teams worked together to build a shared (team) understanding, also played a key role. Teams with a more "flexible" interpretation, reported the view that the intervention could have benefits in a wide range of scenarios. Those with a more fixed, "rule based" interpretation, found it harder to implement, and perceived the benefits to be more limited. Therapists' concerns that the intervention may impair therapeutic relationships and patient learning were not reflected in how patients experienced it. CONCLUSIONS Changing practice, whether in a research study or in the "real world", is complex. Understanding the process of implementation is crucial to effective research delivery. Implementation frameworks facilitate understanding, and subsequently the systematic and iterative development of strategies for this to be addressed. How teams (rather than individuals) work together is central to how complex interventions are understood and implemented. It is possible that new complex interventions work best in contexts where there are 'flexible' cultures. Researchers should consider, and potentially measure this, before they can effectively implement and evaluate an intervention. TRIAL REGISTRATION Clinical Trials - NCT03792126.
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Affiliation(s)
- Louise Johnson
- University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, Dorset, United Kingdom
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Julia Mardo
- Dorset Healthcare NHS Foundation Trust, Yeatman Hospital, Hospital Lane, Sherborne, Dorset, United Kingdom
| | - Sara Demain
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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18
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Watkins KE, Levack WMM, Rathore FA, C Hay-Smith EJ. Challenges in applying evidence-based practice in stroke rehabilitation: a qualitative description of health professional experience in low, middle, and high-income countries. Disabil Rehabil 2023:1-9. [PMID: 37665337 DOI: 10.1080/09638288.2023.2251396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
Purpose: Evidence-based practice (EBP) is considered central to ethical, effective service delivery in rehabilitation, and the implementation of the World Health Organisation's Rehabilitation Strategy 2030. This study aimed to explore and compare the experiences of health professionals regarding the application of EBP for stroke rehabilitation in each participant's region and country, which provided perspectives from low, middle, and high-income countries.Methods and materials: Interviews were conducted with 12 experienced rehabilitation professionals from 12 different countries (5 high-income, 2 upper-middle income, 3 lower-middle income, and 2 low-income countries) and interpreted using qualitative descriptive analysis.Results: Nine factors influencing evidence-based stroke rehabilitation were: 1) the complexity of rehabilitation research; 2) the (ir)relevance of research to local context; 3) lack of time for EBP; 4) minimal training in EBP; 5) changing health professional behaviours; 6) poor access to resources for developing EBP; 7) influence of culture, patients, and families; 8) language barriers; and 9) lack of access to research evidence. Economic constraints contributed to many challenges; but not all challenges related to the country's economic classification.Conclusion: A global approach is needed to share knowledge about EBP, especially scientific evidence and innovative thinking about its application to clinical practice. Implications for rehabilitationRehabilitation professional groups should contribute to a global network to improve informal knowledge sharing and training around evidence-based practice.Support for training in evidence-based practice and its application needs to be developed and accessible in all countries, including low and middle-income countries.It is imperative that policymakers prioritise practical, evidence-based solutions for rehabilitation research in low and middle-income countries that can be effectively implemented within local settings.There must be solutions and increased accessibility of journal articles for those working in low and middle-income countries including those whose first language is not English.
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Affiliation(s)
- Kimberley E Watkins
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - William M M Levack
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Farooq A Rathore
- Department of Rehabilitation Medicine, PNS Shifa Hospital, DHA-II, Karachi, Pakistan
| | - E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
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Saussez G, Bailly R, Araneda R, Paradis J, Ebner-Karestinos D, Klöcker A, Sogbossi ES, Riquelme I, Brochard S, Bleyenheuft Y. Efficacy of integrating a semi-immersive virtual device in the HABIT-ILE intervention for children with unilateral cerebral palsy: a non-inferiority randomized controlled trial. J Neuroeng Rehabil 2023; 20:98. [PMID: 37516873 PMCID: PMC10385889 DOI: 10.1186/s12984-023-01218-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 07/13/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND The implementation of virtual devices can facilitate the role of therapists (e.g., patient motivation, intensity of practice) to improve the effectiveness of treatment for children with cerebral palsy. Among existing therapeutic devices, none has been specifically designed to promote the application of principles underlying evidence-based motor skill learning interventions. Consequently, evidence is lacking regarding the effectiveness of virtual-based sessions in motor function rehabilitation with respect to promoting the transfer of motor improvements into daily life activities. We tested the effectiveness of implementing a recently developed virtual device (REAtouch®), specifically designed to enable the application of therapeutic motor skill learning principles, during a Hand Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention. METHODS Forty children with unilateral cerebral palsy (5-18 years; MACS I-III; GMFCS I-II) were randomly assigned to a control group or a "REAtouch®" experimental group for a 90-h HABIT-ILE day-camp intervention (two weeks). Children in the REAtouch® group spent nearly half of their one-on-one therapeutic time using the REAtouch®. Participants underwent three testing sessions: the week before (T1), after intervention (T2), and at three months follow-up (T3). The primary outcome was the Assisting Hand Assessment (T3-T1; blinded). Secondary outcomes measured uni-bimanual hand function, stereognosis, gait endurance, daily life abilities, and functional goals. Accelerometers and a manual report of daily activities served to document therapeutic dosage and treatment characteristics. We used one-way RMANOVA to compare the efficacies of the two interventions, and non-inferiority analyses to contrast changes in the "REAtouch®" group versus the "HABIT-ILE" control group. RESULTS We found significant improvements in both groups for most of the outcome measures (p < 0.05). There was significant non-inferiority of changes in the REAtouch® group for upper extremities motor function, functional goals attainment, and abilities in daily life activities (p < 0.05). CONCLUSIONS Use of the REAtouch® device during HABIT-ILE showed non-inferior efficacy compared to the conventional evidence-based HABIT-ILE intervention in children with unilateral cerebral palsy. This study demonstrates the feasibility of using this virtual device in a high dosage camp model, and establishes the possibility of applying the therapeutic principles of motor skill learning during specifically designed virtual-based sessions. TRIAL REGISTRATION Trial registration number: NCT03930836-Registration date on the International Clinical Trials Registry Platform (ICTRP): June 21th, 2018; Registration date on NIH Clinical Trials Registry: April 29th, 2019. First patient enrollment: July 3rd, 2018.
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Affiliation(s)
- G Saussez
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium.
- Motor Sciences department, FfH Lab, CeREF Santé, HELHa, Rue Trieu Kaisin, 136, 6061, Montignies-Sur-Sambre, Belgium.
| | - R Bailly
- Fondation Ildys, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, Brest, France
| | - R Araneda
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - J Paradis
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - D Ebner-Karestinos
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - A Klöcker
- Haute Ecole Leonard de Vinci, Parnasse-ISEI, Brussels, Belgium
| | - E S Sogbossi
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
- School of Physical Therapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - I Riquelme
- Research Institute of Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, Palma, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Spain
| | - S Brochard
- Fondation Ildys, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, Brest, France
| | - Y Bleyenheuft
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
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Yang CL, Connell LA, Eng JJ. Evaluating the Dissemination and Implementation Impact of a Rehabilitation Intervention: The Graded Repetitive Arm Supplementary Program (GRASP). Physiother Can 2023; 75:105-117. [PMID: 37736384 PMCID: PMC10510554 DOI: 10.3138/ptc-2022-0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 09/23/2023]
Abstract
Purpose To evaluate the dissemination and implementation impacts of a rehabilitation intervention. Methods Systematic evaluation of data sources including academic publishing metrics, publications, and surveys was used to describe the dissemination and implementation impact of the graded repetitive arm supplementary program (GRASP). Three categories in the Payback Framework were evaluated: knowledge production and dissemination, benefits to future research and research use, and real-world uptake and implementation. Results In the Knowledge production and dissemination category, seven publications, authored by the GRASP research team, were associated with the GRASP, and there were approximately 17,000 download counts of GRASP manuals from the website from 120 countries. In the Benefits to future research and research use category, 15 studies and 8 registered clinical trials, authored by researchers outside of the GRASP team, have used GRASP as an intervention. In the real-world uptake and implementation category, GRASP has informed recommendations in 2 clinical guidelines and 20 review papers, and had high implementation uptake (e.g., 35% [53/154] of UK therapists surveyed had used GRASP; 95% [649/681] who downloaded GRASP had used it). More than 75% of those who had used GRASP identified that GRASP provides more intensity in upper extremity rehabilitation, is evidence-based and easy to implement, and the equipment and manual are easy to obtain. Conclusion The Payback Framework is useful to evaluate the dissemination and implementation impacts of a rehabilitation intervention. GRASP has been implemented extensively in clinical practice and community in a relatively short time since it has been developed.
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Affiliation(s)
- Chieh-ling Yang
- From the:
Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Louise A. Connell
- School of Sport & Health Sciences, University of Central Lancashire, Preston, United Kingdom
- East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Van Stan JH, Holmes J, Wengerd L, Juckett LA, Whyte J, Pinto SM, Katz LW, Wolfberg J. Rehabilitation Treatment Specification System: Identifying Barriers, Facilitators, and Strategies for Implementation in Research, Education, and Clinical Care. Arch Phys Med Rehabil 2023; 104:562-568. [PMID: 36306923 PMCID: PMC10073238 DOI: 10.1016/j.apmr.2022.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore rehabilitation professionals' experiences and perspectives of barriers and facilitators to implementing the Rehabilitation Treatment Specification System (RTSS) in research, education, and clinical care. DESIGN A cross-sectional survey with free text and binary responses was completed by rehabilitation professionals. Survey data were analyzed with a deductive approach of directed content analysis using 2 implementation science frameworks: Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC). SETTING Rehabilitation professionals across research, educational, and clinical settings. PARTICIPANTS One hundred and eleven rehabilitation professionals-including speech-language pathologists, occupational therapists, physical therapists, physicians, psychologists, researchers, and clinic directors-who explored possible uses or applications of the RTSS for clinical care, education, or research (N=111). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Frequency of reported CFIR barriers and facilitators, as well as keywords related to CFIR and ERIC constructs. RESULTS The barriers and facilitating strategies differed according to the end-users' intended use, that is, research, education, or clinical. Overall, the 4 most frequently encountered CFIR barriers were the RTSS's complexity, a lack of available RTSS resources, reduced access to knowledge and information about the RTSS, and limited knowledge and beliefs about the RTSS. The ERIC-CFIR matching tool identified 7 ERIC strategies to address these barriers, which include conducting educational meetings, developing and distributing educational materials, accessing new funding, capturing and sharing local knowledge, identifying and preparing champions, and promoting adaptability. CONCLUSIONS When attempting to use the RTSS, rehabilitation professionals commonly encountered barriers to understanding and skillfully using the framework. Theory-driven implementation strategies have been identified that have potential for addressing the RTSS's complexity and lack of educational and skill-building resources. Future work can develop the identified implementation strategies and evaluate their effects on RTSS implementation.
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Affiliation(s)
- Jarrad H Van Stan
- Harvard Medical School, Boston, MA; Massachusetts General Hospital, Boston, MA; MGH Institute of Health Professions, Charlestown, MA.
| | - Jain Holmes
- University of Nottingham, Nottingham, England
| | | | | | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA
| | | | - Leanna W Katz
- Spaulding Rehabilitation Hospital, Charlestown, MA; Boston University, Boston, MA
| | - Jeremy Wolfberg
- Massachusetts General Hospital, Boston, MA; MGH Institute of Health Professions, Charlestown, MA
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22
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Vander Veen A, Cammarata M, Renner S, Alvarez L. The Clinical Usefulness of the Practice Resource for Driving after Stroke (PReDAS). Occup Ther Health Care 2023; 37:119-144. [PMID: 34955088 DOI: 10.1080/07380577.2021.2018751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Occupational Therapists (OTs) have identified a critical need for organized, evidence-based resources to approach driving post-stroke. The Practice Resource for Driving After Stroke (PReDAS) is a resource to support the clinical reasoning and practice of health professionals for addressing driving in acute stroke care. The purpose of this pilot study is to evaluate the usefulness of the PReDAS to support clinician and patient decision-making about return to driving after stroke/Transient Ischemic Attack (TIA) in the acute care hospital setting. OTs, physicians, and patients diagnosed with stroke/TIA were surveyed regarding their experience with the PReDAS in acute care. Patient participants were also contacted for a follow-up questionnaire. OT, physician and patient stakeholders reported the PReDAS was useful to support decision-making for driving. The majority of patients recalled information provided in acute care and abstained from driving as advised. This study provides preliminary support for the clinical usefulness of the PReDAS.
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Affiliation(s)
- April Vander Veen
- Integrated Stroke Unit, Grand River Hospital, Kitchener, Canada.,Health and Rehabilitation Sciences, Faculty of Health Sciences London, Western University, London, Canada
| | - Michael Cammarata
- Department of Occupational Therapy, Buffalo, D'Youville College, New York, NY, USA
| | - Sarah Renner
- Integrated Stroke Unit, Grand River Hospital, Kitchener, Canada
| | - Liliana Alvarez
- School of Occupational Therapy, Western University, London, Canada
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23
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Juckett LA, Wengerd LR, Banhos M, Darragh AR. Conducting Implementation Research in Stroke Rehabilitation: A Case Example and Considerations for Study Design. Neurorehabil Neural Repair 2022; 36:770-776. [PMID: 36398961 DOI: 10.1177/15459683221138747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
As neurorehabilitation research continues to grow, the field must ensure its scientific discoveries are implemented into routine clinical care. Without targeted efforts to increase the implementation of evidence into practice, patients may never see the benefits of interventions, assessments, and technologies developed in the confines of empirical studies. This article serves as a response to Lynch et al's 2018 Point of View piece in Neurorehabilitation and Neural Repair that underscored the urgent need for implementation studies to expedite the application of neurorehabilitation evidence in practice. To address this need, we provide the following 4 considerations investigators should contemplate when designing their own studies at the intersection of implementation and neurorehabilitation research: (a) consideration of guiding theories, models, and frameworks, (b) consideration of implementation strategies, (c) considerations of target outcomes, and (d) consideration of hybrid effectiveness-implementation designs. To conclude, we also provide a study exemplar to depict how these considerations can be integrated into the neurorehabilitation research field to narrow the evidence-to-practice gap.
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Affiliation(s)
- Lisa A Juckett
- Division of Occupational Therapy, The Ohio State University, Columbus, OH, USA
| | - Lauren R Wengerd
- Division of Occupational Therapy, The Ohio State University, Columbus, OH, USA
| | - Meredith Banhos
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Amy R Darragh
- Division of Occupational Therapy, The Ohio State University, Columbus, OH, USA
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24
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Yan C, McClure N, Dukelow SP, Mann B, Round J. Optimal Planning of Health Services through Genetic Algorithm and Discrete Event Simulation: A Proposed Model and Its Application to Stroke Rehabilitation Care. MDM Policy Pract 2022; 7:23814683221134098. [PMID: 36310567 PMCID: PMC9597031 DOI: 10.1177/23814683221134098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Abstract
UNLABELLED Background. Increasing demand for provision of care to stroke survivors creates challenges for health care planners. A key concern is the optimal alignment of health care resources between provision of acute care, rehabilitation, and among different segments of rehabilitation, including inpatient rehabilitation, early supported discharge (ESD), and outpatient rehabilitation (OPR). We propose a novel application of discrete event simulation (DES) combined with a genetic algorithm (GA) to identify the optimal configuration of rehabilitation that maximizes patient benefits subject to finite health care resources. Design. Our stroke rehabilitation optimal model (sROM) combines DES and GA to identify an optimal solution that minimizes wait time for each segment of rehabilitation by changing care capacity across different segments. sROM is initiated by generating parameters for DES. GA is used to evaluate wait time from DES. If wait time meets specified stopping criteria, the search process stops at a point at which optimal capacity is reached. If not, capacity estimates are updated, and an additional iteration of the DES is run. To parameterize the model, we standardized real-world data from medical records by fitting them into probability distributions. A meta-analysis was conducted to determine the likelihood of stroke survivors flowing across rehabilitation segments. Results. We predict that rehabilitation planners in Alberta, Canada, have the potential to improve services by increasing capacity from 75 to 113 patients per day for ESD and from 101 to 143 patients per day for OPR. Compared with the status quo, optimal capacity would provide ESD to 138 (s = 29.5) more survivors and OPR to 262 (s = 45.5) more annually while having an estimated net annual cost savings of $25.45 (s = 15.02) million. Conclusions. The combination of DES and GA can be used to estimate optimal service capacity. HIGHLIGHTS We created a hybrid model combining a genetic algorithm and discrete event simulation to search for the optimal configuration of health care service capacity that maximizes patient outcomes subject to finite health system resources.We applied a probability distribution fitting process to standardize real-world data to probability distributions. The process consists of choosing the distribution type and estimating the parameters of that distribution that best reflects the data. Standardizing real-word data to a best-fitted distribution can increase model generalizability.In an illustrative study of stroke rehabilitation care, resource allocation to stroke rehabilitation services under an optimal configuration allows provision of care to more stroke survivors who need services while reducing wait time.Resources needed to expand rehabilitation services could be reallocated from the savings due to reduced wait time in acute care units. In general, the predicted optimal configuration of stroke rehabilitation services is associated with a net cost savings to the health care system.
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Affiliation(s)
- Charles Yan
- Charles Yan, Institute of Health Economics,
1200-10405 Jasper Ave, Edmonton, AB T5J 3N4, Canada;
()
| | - Nathan McClure
- Institute of Health Economics; School of
Publish Health, University of Alberta, Edmonton, AB, Canada
| | - Sean P. Dukelow
- Division of Physical Medicine and
Rehabilitation, Department of Clinical Neuroscience, University of Calgary
and Stroke Rehabilitation, Calgary, AB, Canada
| | - Balraj Mann
- Cardiovascular Health and Stroke Strategic
Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Jeff Round
- Institute of Health Economics, Edmonton, AB,
Canada,Department of Pediatrics, Faculty of Medicine
and Dentistry, University of Alberta, Edmonton, AB, Canada
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25
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Scheffler B, Schimböck F, Schöler A, Rösner K, Spallek J, Kopkow C. Current physical therapy practice and implementation factors regarding the evidence-based 'Rehabilitation of Mobility after Stroke (ReMoS)' guideline in Germany: a cross-sectional online survey. BMC Neurol 2022; 22:284. [PMID: 35907809 PMCID: PMC9338587 DOI: 10.1186/s12883-022-02780-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Evaluation of the current physical therapy practice for German stroke rehabilitation with respect to the 'Rehabilitation of Mobility after Stroke (ReMoS)' guideline recommendations and the associated implementation factors. METHODS A descriptive cross-sectional study employing an online survey was performed among German physical therapists in 2019. The survey consisted of three sections with open and closed questions: 1) self-reported use of ReMoS recommendations, 2) barriers of guideline use and 3) socio-demographic characteristics. The benchmark level for guideline adherent physical therapy was set at > 80%. RESULTS Data from 170 questionnaires were eligible for analysis. Participants' mean age was 41.6 years, 69.4% were female, while 60.1% had no academic degree. The ReMoS guideline was unknown to 52.9% of the responders. Out of all the 46 ReMoS guideline recommendations, only 'intensive walking training without a treadmill' was reported to be performed in a guideline adherent manner. Respondents usually denied any personal limitations, such as limited knowledge, or that the ReMoS guideline did not fit their routine practice. CONCLUSIONS Among German physical therapists, the ReMoS guideline is not well-known and many interventions are not performed as recommended, illustrating the discrepancies between the ReMoS guideline recommendations and current physical therapy practice. Interventions aimed at overcoming this gap should consider both knowledge of existing barriers and facilitators of guideline usage. TRIAL REGISTRATION The study was retrospectively registered to the German Clinical Trials Register ( DRKS00026681 ).
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Affiliation(s)
- Bettina Scheffler
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus-Senftenberg, Universitaetsplatz 1, 01968, Senftenberg, Germany.
| | - Florian Schimböck
- Department of Nursing Sciences and Clinical Nursing, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Almut Schöler
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus-Senftenberg, Universitaetsplatz 1, 01968, Senftenberg, Germany
| | - Katrin Rösner
- Institute of Health Sciences, Department of Physiotherapy, University of Luebeck, Lübeck, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Christian Kopkow
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus-Senftenberg, Universitaetsplatz 1, 01968, Senftenberg, Germany
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26
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Juckett LA, Schmidt EK, Tanner KJ, Sagester G, Wengerd LR, Hunter EG, Lieberman D, Richardson H. Development and Refinement of the American Occupational Therapy Association's Knowledge Translation Toolkit. Am J Occup Ther 2022; 76:23282. [PMID: 35648121 DOI: 10.5014/ajot.2022.047076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy practitioners are expected to translate promising discoveries from empirical research into routine practice with their clients. However, complex barriers can influence practitioners' knowledge translation (KT) efforts, leading the American Occupational Therapy Association's Evidence-Based Practice (EBP) group to develop the KT Toolkit tailored to the perceived needs of occupational therapists and occupational therapy assistants. OBJECTIVE To identify common barriers to implementing EBPs and potential strategies to support EBP uptake. DESIGN Cross-sectional survey. SETTING United States. PARTICIPANTS Occupational therapy practitioners. OUTCOMES AND MEASURES Data underwent descriptive and directed content analysis, the latter of which was guided by the Consolidated Framework for Implementation Research. RESULTS Occupational therapy survey respondents (N = 818) identified common EBP implementation barriers (e.g., lack of time and resources, difficulty understanding research findings). Initial KT Toolkit content was developed to address these barriers and included resources for searching for, analyzing, and applying evidence in practice. CONCLUSIONS AND RELEVANCE Survey findings have informed the development of the KT Toolkit, which includes resources designed to support occupational therapy practitioners' EBP implementation efforts. This KT Toolkit is available at AOTA.org and will be continuously revised and updated on an ongoing basis. What This Article Adds: Several barriers limit the extent to which occupational therapy practitioners can implement evidence with their client populations. The KT Toolkit is directly informed by practitioner input and provides resources to support practitioners in their efforts to translate knowledge into real-world practice.
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Affiliation(s)
- Lisa A Juckett
- Lisa A. Juckett, PhD, OTR/L, CHT, is Assistant Professor, Division of Occupational Therapy, The Ohio State University, Columbus;
| | - Elizabeth K Schmidt
- Elizabeth K. Schmidt, PhD, OTR/L, is Assistant Professor, Lincoln Memorial University, Harrogate, TN
| | - Kelly Jane Tanner
- Kelly Jane Tanner, PhD, OTR/L, BCP, is Clinical Researcher, Nationwide Children's Hospital, Columbus, OH
| | - Grace Sagester
- Grace Sagester, OTD, OTR/L, BCP, is Occupational Therapist I, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lauren R Wengerd
- Lauren R. Wengerd, PhD, OTR/L, is Lecturer, Division of Occupational Therapy, The Ohio State University, Columbus
| | - Elizabeth G Hunter
- Elizabeth G. Hunter, PhD, OTR/L, is Assistant Professor, Graduate Center for Gerontology, Department of Health, Behavior, and Society, University of Kentucky, Lexington
| | - Deborah Lieberman
- Deborah Lieberman, MHSA, OTR/L, FAOTA, is Vice President, Practice Improvement, American Occupational Therapy Association, North Bethesda, MD
| | - Hillary Richardson
- Hillary Richardson, MOT, OTR/L, is Practice Manager, American Occupational Therapy Association, North Bethesda, MD
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27
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Teasell R, McIntyre A, Viana R, Bateman EA, Murie-Fernandez M, Janzen S, Saikaley M. Developing a framework for utilizing adjunct rehabilitation therapies in motor recovery of upper extremity post stroke. Top Stroke Rehabil 2022; 30:493-500. [PMID: 35488362 DOI: 10.1080/10749357.2022.2070364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Standardization of first principles has transformed stroke rehabilitation in developed countries and helped guide the appropriate allocation of resources to ensure better outcomes for patients. There have been challenges in incorporating new evidence into stroke rehabilitation practices. The sheer number of RCTs can be daunting to the average clinician, made worse by the lack of a framework for their application. OBJECTIVES To develop a framework for the introduction of adjunct practices for the motor recovery of the upper extremity post stroke into clinical practice. METHODOLOGY A literature search following PRISMA guidelines revealed 1,307 RCTs involving rehabilitation interventions for the hemiparetic upper extremity post stroke. RESULTS Therapies were divided into three categories of therapies: (1) Basic Conventional Therapy Approaches (<15% of interventions), (2) Adjunct Therapies Designed to Enhance Conventional Therapies (>85% of interventions), and (3) Treatment to Manage Complications (~9% of interventions). Adjunct Therapies, despite having a spectacular evidence base, are often not employed clinically. To encourage their clinical use, we have developed a framework that divides adjunct therapies into two categories: (1) Treatments that Stimulate the Brain (i.e. rTMS, mental practice, and virtual reality) and (2) Treatments that Peripherally Facilitate the Hemiparetic Upper Extremity (i.e. robotics, EMG Biofeedback, and Constraint-induced Movement Therapy). CONCLUSION To allow stroke rehabilitation to continue to improve upper extremity recovery and outcomes, we propose a new intuitive framework that is based on a strong evidence base to guide clinicians and improve stroke rehabilitation.
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Affiliation(s)
- Robert Teasell
- Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, London, Canada.,Parkwood Institute, St. Joseph's Health Care London, London, Canada.,Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Amanda McIntyre
- Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, London, Canada
| | - Ricardo Viana
- Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, London, Canada.,Parkwood Institute, St. Joseph's Health Care London, London, Canada.,Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Emma A Bateman
- Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, London, Canada.,Parkwood Institute, St. Joseph's Health Care London, London, Canada.,Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | | | - Shannon Janzen
- Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, London, Canada
| | - Marcus Saikaley
- Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, London, Canada
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28
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Wang H, Ghazi M, Chandrashekhar R, Rippetoe J, Duginski GA, Lepak LV, Milhan LR, James SA. User Participatory Design of a Wearable Focal Vibration Device for Home-Based Stroke Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2022; 22:3308. [PMID: 35590997 PMCID: PMC9105527 DOI: 10.3390/s22093308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Stroke often leads to the significant impairment of upper limb function and is associated with a decreased quality of life. Despite study results from several interventions for muscle activation and motor coordination, wide-scale adoption remains largely elusive due to under-doses and low user compliance and participation. Recent studies have shown that focal vibration has a greater potential to increase and coordinate muscle recruitment and build muscle strength and endurance. This form of treatment could widely benefit stroke survivors and therapists. Thus, this study aimed to design and develop a novel wearable focal vibration device for upper limb rehabilitation in stroke survivors. A user participatory design approach was used for the design and development. Five stroke survivors, three physical therapists, and two occupational therapists were recruited and participated. This pilot study may help to develop a novel sustainable wearable system providing vibration-based muscle activation for upper limb function rehabilitation. It may allow users to apply the prescribed vibratory stimuli in-home and/or in community settings. It may also allow therapists to monitor treatment usage and user performance and adjust the treatment doses based on progression.
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Affiliation(s)
- Hongwu Wang
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32603, USA
| | - Mustafa Ghazi
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | | | - Josiah Rippetoe
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | - Grace A Duginski
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Louis V Lepak
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | - Lisa R Milhan
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | - Shirley A James
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
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Skidmore ER, Shih M. Stroke Rehabilitation: Recent Progress and Future Promise. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2022; 42:175-181. [PMID: 35341386 DOI: 10.1177/15394492221082630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Significant advancements in acute stroke medical management have changed stroke rehabilitation. In addition, an ever-changing health care ecosystem and heightened awareness of continued and new challenges requires that the occupational therapy profession consider new, innovative, and pragmatic approaches to measurement, intervention, and health services research, and clinical practice. The profession must elevate the focus and rigor of research examining occupation and participation after stroke, and their associations with health. Intervention research must progress beyond early phase pilot studies to a robust collection of meaningful large multisite studies that demonstrate the effectiveness of our interventions and the effectiveness of wide-scale implementation to ensure quality and consistent delivery of evidence-based practices in occupational therapy. These studies must address the accessibility of these practices for all people who have sustained stroke, and particularly those people who are most vulnerable to inaccessible stroke rehabilitation service delivery systems.
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Oral A. Are implementation interventions effective in promoting the adoption of evidence-based practices in stroke rehabilitation? A Cochrane Review summary with commentary. NeuroRehabilitation 2022; 50:255-258. [DOI: 10.3233/nre-228008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Stroke is the leading cause of disability among neurological disorders. Evidence-based practices to reduce disability are presumed to be associated with more favorable outcomes. OBJECTIVE: To assess whether implementation interventions are effective at increasing uptake of evidence-based practices in stroke rehabilitation. METHODS: The Cochrane Review by Cahill et al. (2020) is summarized. RESULTS: The effectiveness of implementation interventions on health professionals’ use of evidence- based practices is uncertain. CONCLUSIONS: There is an urgent need for future research investigating the utility of implementation interventions to ensure the uptake of evidence by health professionals for the benefit of stroke survivors.
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Affiliation(s)
- Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey. E-mail:
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31
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McQuaid L, Thomson K, Bannigan K. Case study research: Building the occupational therapy evidence base one case at a time. Scand J Occup Ther 2022; 30:435-443. [PMID: 35171068 DOI: 10.1080/11038128.2022.2039758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is growing recognition in healthcare that evidence from randomised controlled trials may not be appropriate to answer the full spectrum of practice-based questions and a more pluralistic approach is needed. AIM To consider the use of case study research in contributing to the occupational therapy evidence base. MATERIAL AND METHODS A critical discussion of the current state of evidence-based practice in occupational therapy and exploration of a viable approach to case study research is used. RESULTS Case study research can capture the context and complexity of occupational therapy practice. Cases can then be pooled to make a substantial contribution to the evidence base. CONCLUSIONS Occupational therapists should consider the use of case study research to produce practice related, meaningful research. Journal editorial boards need to be mindful of the value of high-quality case study research when considering publication priorities in occupational therapy literature. SIGNIFICANCE Highlights a changing landscape in the literature about how best to conduct research in health and social care, particularly for complex interventions and describes a pragmatic approach to case study research for occupational therapy.
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Affiliation(s)
- Leona McQuaid
- Department of Occupational Therapy Human Nutrition and Dietetics, Glasgow Caledonian University, Glasgow, Scotland
| | - Katie Thomson
- Department of Occupational Therapy Human Nutrition and Dietetics, Glasgow Caledonian University, Glasgow, Scotland
| | - Katrina Bannigan
- Department of Occupational Therapy Human Nutrition and Dietetics, Glasgow Caledonian University, Glasgow, Scotland
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Auditing integrated stroke care to support quality improvement activities: development of a peer-to-peer audit framework. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-06-2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeTo organize stroke care, multiple stakeholders work closely together in integrated stroke care services (ISCS). However, even a well-developed integrated care program needs a continuous quality improvement (CQI) cycle. The current paper aims to describe the development of a unique peer-to-peer audit framework, the development model for integrated care (DMIC), the Dutch stroke care standard and benchmark indicators for stroke.Design/methodology/approachA group of experts was brought together in 2016 to discuss the aims and principles of a national audit framework. The steering group quality assurance (SGQA) consisted of representatives of a diversity of professions in the field of stroke care in the Netherlands, including managers, nurses, medical specialists and paramedics.FindingsAuditors, coordinators and professionals evaluated the framework, agreed on that the framework was easy to use and valued the interesting and enjoyable audits, the compliments, feedback and fruitful insights. Participants consider that a quality label may help to overcome necessity issues and have health care insurers on board. Finally, a structured improvement plan after the audit is needed.Originality/valueAn audit offers fruitful insights into the functioning of an ISCS and the collaboration therein. Best practices and points of improvement are revealed and can fuel collaboration and the development of partnerships. Innovative cure and care may lead to an increasing area of support among professionals in the ISCS and consequently lead to improved quality of delivered stroke care.
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Kinney AR, Fields B, Juckett L, Read H, Martino MN, Weaver JA. Learning Health Systems Can Promote and Sustain High-Value Occupational Therapy. Am J Occup Ther 2022; 76:23117. [PMID: 34962517 DOI: 10.5014/ajot.2022.049071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the current policy context, the occupational therapy profession must act to promote and sustain high-value care. Stakeholders have delineated efforts, such as defining and measuring high-quality care processes or promoting the adoption of evidence into practice, that can enhance the value of occupational therapy services. There is a growing recognition, however, that low-value care is the product of deficiencies within health care systems and is therefore most amenable to system-level solutions. To date, the specific nature of system-level changes capable of identifying and rectifying low-value occupational therapy has yet to be elucidated. In this "The Issue Is. . ." column, we introduce occupational therapy to the Learning Health System concept and its essential functions. Moreover, we discuss action steps for occupational therapy stakeholders to lay the foundation for Learning Health Systems in their own professional contexts. What This Article Adds: This article is the first to outline concrete action steps needed to transform occupational therapy practice contexts into Learning Health Systems. Such a transformation would represent a system-level change capable of fostering the delivery of high-value occupational therapy services to clients in a variety of practice settings.
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Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Assistant Professor, Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, CO, and Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora;
| | - Beth Fields
- Beth Fields, PhD, OTR/L, BCG, is Assistant Professor, Department of Kinesiology, School of Education, University of Wisconsin-Madison
| | - Lisa Juckett
- Lisa Juckett, PhD, OTR/L, CHT, is Assistant Professor, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Halley Read
- Halley Read, MOT, OTR/L, is Clinical Assistant Professor, School of Occupational Therapy, College of Health Professions, Pacific University, Hillsboro, OR
| | - M Nicole Martino
- M. Nicole Martino, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy Education, Department of Health and Rehabilitation Sciences, University of Nebraska Medical Center, Omaha
| | - Jennifer A Weaver
- Jennifer A. Weaver, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins
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Murrell JE, Pisegna JL, Juckett LA. Implementation strategies and outcomes for occupational therapy in adult stroke rehabilitation: a scoping review. Implement Sci 2021; 16:105. [PMID: 34922568 PMCID: PMC8684217 DOI: 10.1186/s13012-021-01178-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- J Edward Murrell
- Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Janell L Pisegna
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Lisa A Juckett
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
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Bozec E, Gorska J, Grampurohit N. Upper Extremity Task-Specific Training: Manual Development and Implementation Research within Inpatient Rehabilitation. Occup Ther Health Care 2021; 35:336-354. [PMID: 34181500 DOI: 10.1080/07380577.2021.1938338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 05/21/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
A structured program of manualization and implementation of neurologic upper extremity task-specific training was developed at an inpatient rehabilitation hospital. The study used the Consolidated Framework for Implementation Research and engaged 31 stakeholders in manual refinement and examination of barriers after a year of training and use. Occupational therapists, occupational therapy assistants, and clinical educators provided input for manual revisions until consensus was achieved on usability, applicability, and implementation. Practitioners reported barriers such as intervention complexity, insufficient idea sharing for implementation, and a lack of motivators outside of the organization. The results can inform future implementation research in occupational therapy.Supplemental data for this article is available online at https://doi.org/10.1080/07380577.2021.1938338 .
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Affiliation(s)
- Eron Bozec
- Outpatient Day Rehabilitation, Northwestern Medicine Marianjoy Rehabilitation Hospital, Wheaton, IL, USA
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jaime Gorska
- Outpatient Day Rehabilitation, Northwestern Medicine Marianjoy Rehabilitation Hospital, Wheaton, IL, USA
| | - Namrata Grampurohit
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
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Romney W, Bellows DM, Tavernite JP, Salbach N, Deutsch JE. Knowledge Translation Research to Promote Behavior Changes in Rehabilitation: Use of Theoretical Frameworks and Tailored Interventions: A Scoping Review. Arch Phys Med Rehabil 2021; 103:S276-S296. [PMID: 33561438 DOI: 10.1016/j.apmr.2021.01.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/27/2020] [Accepted: 01/01/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To describe knowledge translation (KT) research as a means of changing practice behaviors in rehabilitation. We specifically aimed to explore how theories, models, and frameworks (TMFs) are used to guide KT, guide methods to tailor KT interventions, and evaluate outcomes. We hypothesized these methods would have increased over the past 10 years. DATA SOURCES We identified articles through searches conducted using databases Cumulative Index to Nursing and Allied Health, MEDLINE, PubMed, Academic Search Premier, and previous reviews from January 2000 to April 2020. Search terms included physical therapy, occupational therapy, speech-language pathology, knowledge translation, and knowledge-to-action (KTA). STUDY SELECTION Two authors interpedently screened titles, abstracts, and full-text articles. Studies were included if behavior change of rehabilitation practitioners was measured. Systematic reviews, protocols, and capacity-building interventions were excluded. DATA EXTRACTION Three authors extracted information on study design, theoretical frameworks, intervention strategies, and outcome evaluation. DATA SYNTHESIS Fifty-six studies were included in the review. Sixteen (29%) reported the use of a theoretical framework to guide the KT process. Since 2013, the KTA framework was used 35% of the time. Twenty-two studies (39%) reported barrier assessments to tailor interventions, and 82% were published after 2013. However, barrier assessment in the local context was only conducted 64% of the time. Outcomes of tailored interventions were most frequently measured using chart audits (50%) and questionnaires (41%). Further, the link between KT theory, specific barriers, and selection of intervention strategies was not consistently described. CONCLUSIONS Over the past 7 years, there has been an increase in the use of KT TMFs and tailored interventions. Recommendations for future research include the use of TMFs to guide local barrier assessment, KT strategy selection, intervention development, and overall KT process and mapping barriers to selected intervention strategies.
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Affiliation(s)
- Wendy Romney
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT; Department of Rehabilitation and Movement Sciences, RIVERS Lab, Rutgers University, Newark, NJ.
| | | | - Jake P Tavernite
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT
| | - Nancy Salbach
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; KITE-Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Judith E Deutsch
- Department of Rehabilitation and Movement Sciences, RIVERS Lab, Rutgers University, Newark, NJ
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Pérez-Escamilla B, Benrimoj SI, Martínez-Martínez F, Gastelurrutia MÁ, Varas-Doval R, Musial-Gabrys K, Garcia-Cardenas V. Using network analysis to explore factors moderating the implementation of a medication review service in community pharmacy. Res Social Adm Pharm 2020; 18:2432-2443. [PMID: 33461944 DOI: 10.1016/j.sapharm.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/20/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Implementation factors are hypothesised to moderate the implementation of innovations. Although individual barriers and facilitators have been identified for the implementation of different evidence-based services in pharmacy, relationships between implementation factors are usually not considered. OBJECTIVES To examine how a network of implementation factors and the position of each factor within this network structure influences the implementation of a medication review service in community pharmacy. METHODS A mixed methods approach was used. Medication review with follow-up service was the innovation to be implemented over 12 months in community pharmacies. A network analysis to model relationships between implementation factors was undertaken. Two networks were created. RESULTS Implementation factors hindering the service implementation with the highest centrality measures were time, motivation, recruitment, individual identification with the organization and personal characteristics of the pharmacists. Three hundred and sixty-nine different interrelationships between implementation factors were identified. Important causal relationships between implementation factors included: workflow-time; characteristics of the pharmacy-time; personal characteristics of the pharmacists-motivation. Implementation factors facilitating the implementation of the service with highest centrality scores were motivation, individual identification with the organization, beliefs, adaptability, recruitment, external support and leadership. Four hundred and fifty-six different interrelationships were identified. The important causal relationships included: motivation-external support; structure-characteristics of the pharmacy; demographics-location of the pharmacy. CONCLUSION Network analysis has proven to be a useful technique to explore networks of factors moderating the implementation of a pharmacy service. Relationships were complex with most implementation factors being interrelated. Motivation and individual identification with the organisation seemed critical factors in both hindering and facilitating the service implementation. The results can inform the design of implementation programs and tailored strategies to promote faster implementation of innovations in pharmacy.
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Affiliation(s)
- Beatriz Pérez-Escamilla
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Sección de Farmacia Asistencial, Social y Legal, 5(a) planta, 18011, Granada, Spain.
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Sección de Farmacia Asistencial, Social y Legal, 5(a) planta, 18011, Granada, Spain.
| | - Fernando Martínez-Martínez
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Sección de Farmacia Asistencial, Social y Legal, 5(a) planta, 18011, Granada, Spain.
| | - Miguel Ángel Gastelurrutia
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Sección de Farmacia Asistencial, Social y Legal, 5(a) planta, 18011, Granada, Spain.
| | - Raquel Varas-Doval
- General Pharmaceutical Council of Spain, Consejo General de Colegios Oficiales de Farmacéuticos, Calle Villanueva 11, 7(a) planta, 28001, Madrid, Spain.
| | - Katarzyna Musial-Gabrys
- University of Technology Sydney, School of Computer Science, Advanced Analytics Institute, School of Computer Science, Faculty of Engineering and IT, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Victoria Garcia-Cardenas
- University of Technology Sydney, Faculty of Health, Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
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He J, Guo Z, Shao Z, Zhao J, Dan G. An LSTM-Based Prediction Method for Lower Limb Intention Perception by Integrative Analysis of Kinect Visual Signal. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:8024789. [PMID: 32774824 PMCID: PMC7396070 DOI: 10.1155/2020/8024789] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022]
Abstract
Recently, computer vision and deep learning technology has been applied in various gait rehabilitation researches. Considering the long short-term memory (LSTM) network has been proved an excellent performance in learn sequence feature representations, we proposed a lower limb joint trajectory prediction method based on LSTM for conducting active rehabilitation on a rehabilitation robotic system. Our approach based on synergy theory exploits that the follow-up lower limb joint trajectory, i.e. limb intention, could be generated by joint angles of the previous swing process of upper limb which were acquired from Kinect platform, an advanced computer vision platform for motion tracking. A customize Kinect-Treadmill data acquisition platform was built for this study. With this platform, data acquisition on ten healthy subjects is processed in four different walking speeds to acquire the joint angles calculated by Kinect visual signals of upper and lower limb swing. Then, the angles of hip and knee in one side which were presented as lower limb intentions are predicted by the fore angles of the elbow and shoulder on the opposite side via a trained LSTM model. The results indicate that the trained LSTM model has a better estimation of predicting the lower limb intentions, and the feasibility of Kinect visual signals has been validated as well.
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Affiliation(s)
- Jie He
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518056, China
| | - Zhexiao Guo
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518056, China
| | - Ziwei Shao
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518056, China
| | - Junhao Zhao
- Zhejiang Provincial Hospital of Traditional Clinical Medical, Hangzhou 310006, China
| | - Guo Dan
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518056, China
- Shenzhen Institute of Neuroscience, Shenzhen 518060, China
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