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Implementation Science
Published in: Implementation Science 1/2017

Open Access 01-12-2017 | Research

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

Authors: Nancy M. Salbach, Sharon Wood-Dauphinee, Johanne Desrosiers, Janice J. Eng, Ian D. Graham, Susan B. Jaglal, Nicol Korner-Bitensky, Marilyn MacKay-Lyons, Nancy E. Mayo, Carol L. Richards, Robert W. Teasell, Merrick Zwarenstein, Mark T. Bayley, on behalf of the Stroke Canada Optimization of Rehabilitation By Evidence – Implementation Trial (SCORE-IT) Team

Published in: Implementation Science | Issue 1/2017

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Abstract

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
Appendix
Available only for authorised users
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Metadata
Title
Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial
Authors
Nancy M. Salbach
Sharon Wood-Dauphinee
Johanne Desrosiers
Janice J. Eng
Ian D. Graham
Susan B. Jaglal
Nicol Korner-Bitensky
Marilyn MacKay-Lyons
Nancy E. Mayo
Carol L. Richards
Robert W. Teasell
Merrick Zwarenstein
Mark T. Bayley
on behalf of the Stroke Canada Optimization of Rehabilitation By Evidence – Implementation Trial (SCORE-IT) Team
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2017
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-017-0631-7

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