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.

BackgroundEvery year, millions of people worldwide experience a stroke. Given the degree of physical, cognitive, visual, and behavioral impairments post-stroke, stroke survivors often encounter occupational therapy practitioners in the rehabilitation practice settings. Although evidence-based occupational therapy practices have been well-established in the stroke literature, it remains unclear what strategies have been used to promote these practices' effective implementation in the real-world context. The present review identifies these strategies and the extent to which researchers have measured implementation outcomes. MethodsA scoping review protocol was developed to assess the breadth and depth of occupational therapy literature examining implementation strategies and outcomes in the stroke rehabilitation field. Four electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer, as needed, to achieve consensus. The Expert Change guided synthesis of review findings for Implementing Change project and the Implementation Outcomes Framework. ResultsThe initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were deployed in the included studies. The most used implementation strategies were “distribute educational materials,” “assess for readiness and identify barriers and facilitators,” and “conduct educational outreach visits.” “Adoption” was the most frequently measured implementation outcome, while “cost” was not measured in any included studies. Eleven studies reported findings to support the effectiveness of their implementation strategy or strategies; eleven studies reported inconclusive findings, and four studies found that their strategies did not lead to improved implementation outcomes. ConclusionsThis scoping review identified occupational therapy literature examining implementation strategies and outcomes in the context of stroke rehabilitation. With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the uptake of evidence-based practices into routine stroke care. Occupational therapy researchers and practitioners are encouraged to collaborate to develop and deploy implementation strategies responsive to known implementation barriers and facilitators in the stroke rehabilitation setting.

Date Presented 04/02/2022 This research describes implementation strategies and outcomes commonly leveraged to support evidence implementation in adult stroke rehabilitation. Presenters will share findings from their scoping review that examined the effectiveness of implementation strategies with practitioners in stroke rehabilitation settings. This study addresses the research priority concerning the need to progress beyond implementation barriers to examining implementation strategies to overcome them. Primary Author and Speaker: James Edward Murrell Additional Authors and Speakers: Janell Pisegna, Lisa Juckett