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Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial

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...

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Autores principales: Salbach, Nancy M., Wood-Dauphinee, Sharon, Desrosiers, Johanne, Eng, Janice J., Graham, Ian D., Jaglal, Susan B., Korner-Bitensky, Nicol, MacKay-Lyons, Marilyn, Mayo, Nancy E., Richards, Carol L., Teasell, Robert W., Zwarenstein, Merrick, Bayley, Mark T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539742/
https://www.ncbi.nlm.nih.gov/pubmed/28764752
http://dx.doi.org/10.1186/s13012-017-0631-7
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author Salbach, Nancy M.
Wood-Dauphinee, Sharon
Desrosiers, Johanne
Eng, Janice J.
Graham, Ian D.
Jaglal, Susan B.
Korner-Bitensky, Nicol
MacKay-Lyons, Marilyn
Mayo, Nancy E.
Richards, Carol L.
Teasell, Robert W.
Zwarenstein, Merrick
Bayley, Mark T.
author_facet Salbach, Nancy M.
Wood-Dauphinee, Sharon
Desrosiers, Johanne
Eng, Janice J.
Graham, Ian D.
Jaglal, Susan B.
Korner-Bitensky, Nicol
MacKay-Lyons, Marilyn
Mayo, Nancy E.
Richards, Carol L.
Teasell, Robert W.
Zwarenstein, Merrick
Bayley, Mark T.
author_sort Salbach, Nancy M.
collection PubMed
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 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13012-017-0631-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-55397422017-08-03 Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial Salbach, Nancy M. Wood-Dauphinee, Sharon Desrosiers, Johanne Eng, Janice J. Graham, Ian D. Jaglal, Susan B. Korner-Bitensky, Nicol MacKay-Lyons, Marilyn Mayo, Nancy E. Richards, Carol L. Teasell, Robert W. Zwarenstein, Merrick Bayley, Mark T. Implement Sci Research 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 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13012-017-0631-7) contains supplementary material, which is available to authorized users. BioMed Central 2017-08-01 /pmc/articles/PMC5539742/ /pubmed/28764752 http://dx.doi.org/10.1186/s13012-017-0631-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Salbach, Nancy M.
Wood-Dauphinee, Sharon
Desrosiers, Johanne
Eng, Janice J.
Graham, Ian D.
Jaglal, Susan B.
Korner-Bitensky, Nicol
MacKay-Lyons, Marilyn
Mayo, Nancy E.
Richards, Carol L.
Teasell, Robert W.
Zwarenstein, Merrick
Bayley, Mark T.
Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial
title Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial
title_full Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial
title_fullStr Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial
title_full_unstemmed Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial
title_short Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial
title_sort facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539742/
https://www.ncbi.nlm.nih.gov/pubmed/28764752
http://dx.doi.org/10.1186/s13012-017-0631-7
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