Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2014

Open Access 01-12-2014 | Research

A formative evaluation of the implementation of an upper limb stroke rehabilitation intervention in clinical practice: a qualitative interview study

Authors: Louise A Connell, Naoimh E McMahon, Jocelyn E Harris, Caroline L Watkins, Janice J Eng

Published in: Implementation Science | Issue 1/2014

Login to get access

Abstract

Background

The Graded Repetitive Arm Supplementary Program (GRASP) is a hand and arm exercise programme designed to increase the intensity of exercise achieved in inpatient stroke rehabilitation. GRASP was shown to be effective in a randomised controlled trial in 2009 and has since experienced unusually rapid uptake into clinical practice. The aim of this study was to conduct a formative evaluation of the implementation of GRASP to inform the development and implementation of a similar intervention in the United Kingdom.

Methods

Semi-structured interviews were conducted with therapists who were involved in implementing GRASP at their work site, or who had experience of using GRASP. Normalisation Process Theory (NPT), a sociological theory used to explore the processes of embedding innovations in practice, was used to develop an interview guide. Intervention components outlined within the GRASP Guideline Manual were used to develop prompts to explore how therapists use GRASP in practice. Interview transcripts were analysed using a coding frame based on implementation theory.

Results

Twenty interviews were conducted across eight sites in British Columbia Canada. Therapists identified informal networks and the free online availability of GRASP as key factors in finding out about the intervention. All therapists reported positive opinions about the value of GRASP. At all sites, therapists identified individuals who advocated for the use of GRASP, and in six of the eight sites this was the practice leader or senior therapist. Rehabilitation assistants were identified as instrumental in delivering GRASP in almost all sites as they were responsible for organising the GRASP equipment and assisting patients using GRASP. Almost all intervention components were found to be adapted to some degree when used in clinical practice; coverage was wider, the content adapted, and the dose, when monitored, was less.

Conclusions

Although GRASP has translated into clinical practice, it is not always used in the way in which it was shown to be effective. This formative evaluation has informed the development of a novel intervention which aims to bridge this evidence-practice gap in upper limb rehabilitation after stroke.
Appendix
Available only for authorised users
Literature
1.
Van Peppen RPS, Kwakkel G, Wood-Dauphinee S, Hendriks HJM, Van der Wees PJ, Dekker J: The impact of physical therapy on functional outcomes after stroke: what’s the evidence?. Clin Rehabil. 2004, 18: 833-862. 10.1191/0269215504cr843oa.CrossRefPubMed
2.
van der Lee JH, Snels IAK, Beckerman H, Lankhorst GJ, Wagenaar RC, Bouter LM: Exercise therapy for arm function in stroke patients: a systematic review of randomized controlled trials. Clin Rehabil. 2001, 15: 20-31. 10.1191/026921501677557755.CrossRefPubMed
3.
Langhorne P, Coupar F, Pollock A: Motor recovery after stroke: a systematic review. Lancet Neurol. 2009, 8: 741-754. 10.1016/S1474-4422(09)70150-4.CrossRefPubMed
4.
Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G: What is the evidence for physical therapy poststroke? a systematic review and meta-analysis. PLoS One. 2014, 9: e87987-10.1371/journal.pone.0087987.CrossRefPubMedPubMedCentral
5.
Lang C, MacDonald J, Gnip C: Counting repetitions: an observational study of outpatient therapy for people with hemiparesis post-stroke. J Neurol Phys Ther. 2007, 31: 3-10. 10.1097/01.NPT.0000260568.31746.34.CrossRefPubMed
6.
Lang C, MacDonald J, Reisman D, Boyd L, Kimberley T, Schindler-Ivens S, Hornby T, Ross S, Scheets P: Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil. 2009, 90: 1692-1698. 10.1016/j.apmr.2009.04.005.CrossRefPubMedPubMedCentral
7.
Harris JE, Eng JJ, Miller WC, Dawson AS: A self-administered graded repetitive Arm supplementary program (GRASP) improves Arm function during inpatient stroke rehabilitation a multi-site randomized controlled trial. Stroke. 2009, 40: 2123-2128. 10.1161/STROKEAHA.108.544585.CrossRefPubMed
8.
Lindsay MP, Gubitz G, Bayley M, Hill MD, Davies-Schinkel C, Singh S, Phillips S: Canadian Best Practice Recommendations for Stroke Care (Update 2010). On behalf of the Canadian Stroke Strategy Best Practices and Standards Writing Group. 2010, Canadian Stroke Network, Ottawa, Ontario Canada
9.
10.
Connell LA, McMahon NE, Watkins CL, Eng JJ: Therapists’ use of the Graded Repetitive Arm Supplementary Program (GRASP) intervention: a practice implementation survey study. Phys Ther. 2014, 94: 632-643. 10.2522/ptj.20130240.CrossRefPubMedPubMedCentral
11.
Stetler CB, Legro MW, Wallace CM, Bowman C, Guihan M, Hagedorn H, Kimmel B, Sharp ND, Smith JL: The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006, 21 (2): S1-S8. 10.1007/s11606-006-0267-9.CrossRefPubMedPubMedCentral
12.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC:Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009, 4: 50-10.1186/1748-5908-4-50.CrossRefPubMedPubMedCentral
13.
May C, Finch T: Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology. 2009, 43: 535-554. 10.1177/0038038509103208.CrossRef
14.
Hasson H, Blomberg S, Duner A: Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care. Implement Sci. 2012, 7: 23-10.1186/1748-5908-7-23.CrossRefPubMedPubMedCentral
15.
Fixsen D, Naoom S, Blase K, Friedman R, Wallace F: Implementation Research: A Synthesis of the Literature. 2005, University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network, Tampa, FL
16.
Hsieh HF, Shannon SE: Three approaches to qualitative content analysis. Qual Health Res. 2005, 15: 1277-1288. 10.1177/1049732305276687.CrossRefPubMed
17.
McEvoy R, Ballini L, Maltoni S, O’Donnell CA, Mair FS, MacFarlane A: A qualitative systematic review of studies using the normalization process theory to research implementation processes. Implement Sci. 2014, 9: 2-10.1186/1748-5908-9-2.CrossRefPubMedPubMedCentral
18.
Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S: A conceptual framework for implementation fidelity. Implement Sci. 2007, 2: 40-10.1186/1748-5908-2-40.CrossRefPubMedPubMedCentral
19.
Hasson H: Systematic evaluation of implementation fidelity of complex interventions in health and social care. Implement Sci. 2010, 5: 67-10.1186/1748-5908-5-67.CrossRefPubMedPubMedCentral
20.
Connell LA, McMahon NE, Eng JJ, Watkins CL: Prescribing upper limb exercises after stroke: A survey of current UK therapy practice. J Rehab Med. 2014, 46: 212-218.CrossRef
21.
McCluskey A, Vratsistas-Curto A, Schurr K: Barriers and enablers to implementing multiple stroke guideline recommendations: a qualitative study. BMC Health Serv Res. 2013, 13: 323-333. 10.1186/1472-6963-13-323.CrossRefPubMedPubMedCentral
22.
Dannapfel P, Peolsson A, Nilsen P: What supports physiotherapists’ use of research in clinical practice? A qualitative study in Sweden. Implement Sci. 2013, 8: 31-10.1186/1748-5908-8-31.CrossRefPubMedPubMedCentral
23.
Gabbay J, le May A: Evidence based guidelines or collectively constructed `mindlines?’ - Ethnographic study of knowledge management in primary care. BMJ. 2004, 329: 1013-1016A. 10.1136/bmj.329.7473.1013.CrossRefPubMedPubMedCentral
24.
McCormack B, Rycroft-Malone J, DeCorby K, Hutchinson A, Bucknall T, Kent B, Schultz A, Snelgrove-Clarke E, Stetler C, Titler M, Wallin L, Wilson V: A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency. Implement Sci. 2013, 8: 107-10.1186/1748-5908-8-107.CrossRefPubMedPubMedCentral
25.
Farley K, Hanbury A, Thompson C: Gathering opinion leader data for a tailored implementation intervention in secondary healthcare: a randomised trial. BMC Medical Res Methodol. 2014, 14: 38-10.1186/1471-2288-14-38.CrossRef
26.
Harn B, Parisi D, Stoolmiller M:Balancing fidelity with flexibility and Fit: What do we really know about fidelity of implementation in schools?. Except Child. 2013, 79: 181-193.
27.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Q. 2004, 82: 581-629. 10.1111/j.0887-378X.2004.00325.x.CrossRefPubMedPubMedCentral
28.
Kollen BJ, Lennon S, Lyons B, Wheatley-Smith L, Scheper M, Buurke JH, Halfens J, Geurts AC, Kwakkel G: The effectiveness of the Bobath concept in stroke rehabilitation what is the evidence?. Stroke. 2009, 40: e89-e97. 10.1161/STROKEAHA.108.533828.CrossRefPubMed
29.
Durlak JA: The importance of doing well in whatever you do: A commentary on the special section, `Implementation research in early childhood education.’. Early Child Res Q. 2010, 25: 348-357. 10.1016/j.ecresq.2010.03.003.CrossRef
30.
Baker CN, Kupersmidt JB, Voegler-Lee ME, Arnold DH, Willoughby MT: Predicting teacher participation in a classroom-based, integrated preventive intervention for preschoolers. Early Child Res Q. 2010, 25: 270-283. 10.1016/j.ecresq.2009.09.005.CrossRefPubMedPubMedCentral
31.
Leon N, Lewin S, Mathews C: Implementing a provider-initiated testing and counselling (PITC) intervention in Cape town, South Africa: a process evaluation using the normalisation process model. Implement Sci. 2013, 8: 97-10.1186/1748-5908-8-97.CrossRefPubMedPubMedCentral
32.
Lloyd A, Joseph-Williams N, Edwards A, Rix A, Elwyn G: Patchy `coherence’: using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC). Implement Sci. 2013, 8: 102-10.1186/1748-5908-8-102.CrossRefPubMedPubMedCentral
33.
Arditi C, Rege-Walther M, Wyatt JC, Durieux P, Burnand B: Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2012, 12: CD001175-PubMed
34.
Giguere A, Legare F, Grimshaw J, Turcotte S, Fiander M, Grudniewicz A, Makosso-Kallyth S, Wolf FM, Farmer AP, Gagnon M-P: Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012, 10: CD004398-PubMed
35.
Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O’Brien MA, Johansen M, Grimshaw J, Oxman AD: Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012, 6: CD000259-PubMed
36.
Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD: Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009, 2: CD003030-PubMed
37.
Ivers NM, Sales A, Colquhoun H, Michie S, Foy R, Francis JJ, Grimshaw JM: No more `business as usual’with audit and feedback interventions: towards an agenda for a reinvigorated intervention. Implement Sci. 2014, 9: 14-10.1186/1748-5908-9-14.CrossRefPubMedPubMedCentral
38.
Clarke DJ, Godfrey M, Hawkins R, Sadler E, Harding G, Forster A, McKevitt C, Dickerson J, Farrin A: Implementing a training intervention to support caregivers after stroke: a process evaluation examining the initiation and embedding of programme change. Implement Sci. 2013, 8: 96-10.1186/1748-5908-8-96.CrossRefPubMedPubMedCentral
39.
Gherardi S: Practice-based theorizing on learning and knowing in organizations. Organization. 2000, 7: 211-223. 10.1177/135050840072001.CrossRef
40.
Damschroder LJ, Lowery JC: Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR). Implement Sci. 2013, 8: 51-10.1186/1748-5908-8-51.CrossRefPubMedPubMedCentral
41.
42.
Flottorp SA, Oxman AD, Krause J, Musila NR, Wensing M, Godycki-Cwirko M, Baker R, Eccles MP: A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement Sci. 2013, 8: 35-10.1186/1748-5908-8-35.CrossRefPubMedPubMedCentral
Metadata
Title
A formative evaluation of the implementation of an upper limb stroke rehabilitation intervention in clinical practice: a qualitative interview study
Authors
Louise A Connell
Naoimh E McMahon
Jocelyn E Harris
Caroline L Watkins
Janice J Eng
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2014
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-014-0090-3

Other articles of this Issue 1/2014

Implementation Science 1/2014 Go to the issue

Short report

The development and application of audit criteria for assessing knowledge exchange plans in health research grant applications

Study protocol

Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee and total hip replacement: study rationale and design

Systematic review

A qualitative systematic review of studies using the normalization process theory to research implementation processes

Systematic review

Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks

Study protocol

Implementation and evaluation of the 5As framework of obesity management in primary care: design of the 5As Team (5AsT) randomized control trial

Study protocol

Engaging Pediatric Intensive Care Unit (PICU) clinical staff to lead practice improvement: the PICU Participatory Action Research Project (PICU-PAR)