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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: Process evaluation of a cluster randomized trial
Implementation Science, Volume 12, No. 1, Article 100, Year 2017
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Description
Background: The Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT) showed that a facilitated knowledge translation (KT) approach to implementing a stroke rehabilitation guideline was more likely than passive strategies to improve functional walking capacity, but not gross manual dexterity, among patients in rehabilitation hospitals. This paper presents the results of a planned process evaluation designed to assess whether the type and number of recommended treatments implemented by stroke teams in each group would help to explain the results related to patient outcomes. Methods: As part of a cluster randomized trial, 20 rehabilitation units were stratified by language and allocated to a facilitated or passive KT intervention group. Sites in the facilitated group received the guideline with treatment protocols and funding for a part-time nurse and therapist facilitator who attended a 2-day training workshop and promoted guideline implementation for 16 months. Sites in the passive group received the guideline excluding treatment protocols. As part of a process evaluation, nurses, and occupational and physical therapists, blinded to study hypotheses, were asked to record their implementation of 18 recommended treatments targeting motor function, postural control and mobility using individualized patient checklists after treatment sessions for 2 weeks pre- and post-intervention. The percentage of patients receiving each treatment pre- and post-intervention and between groups was compared after adjusting for clustering and covariates in a random-effects logistic regression analysis. Results: Data on treatment implementation from nine and eight sites in the facilitated and passive KT group, respectively, were available for analysis. The facilitated KT intervention was associated with improved implementation of sit-to-stand (p = 0.028) and walking (p = 0.043) training while the passive KT intervention was associated with improved implementation of standing balance training (p = 0.037), after adjusting for clustering at patient and provider levels and covariates. Conclusions: Despite multiple strategies and resources, the facilitated KT intervention was unsuccessful in improving integration of 18 treatments concurrently. The facilitated approach may not have adequately addressed barriers to integrating numerous treatments simultaneously and complex treatments that were unfamiliar to providers. Trial registration: Unique identifier- NCT00359593 © 2017 The Author(s).
Authors & Co-Authors
Eng, Janice J.
Canada, Vancouver
The University of British Columbia
Graham, Ian D.
Canada, Ottawa
University of Ottawa
MacKay-Lyons, M. J.
Canada, Halifax
Dalhousie University
Richards, Carol L.
Canada, Quebec
Université Laval, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale
Teasell, Robert
Unknown Affiliation
Zwarenstein, Merrick F.
Canada, London
Western University
Bayley, Mark T.
Canada, Toronto
University Health Network University of Toronto
Statistics
Citations: 31
Authors: 7
Affiliations: 10
Identifiers
Doi:
10.1186/s13012-017-0631-7
ISSN:
17485908
Research Areas
Disability
Health System And Policy
Noncommunicable Diseases
Study Design
Randomised Control Trial
Study Approach
Quantitative