The aim of this study was to employ knowledge user perspectives to develop recommendations that facilitate implementation of a complex, shared decision‐making (SDM)‐based intervention in an interprofessional setting. This study was part of a larger knowledge translation (KT) study in which interprofessional teams from five freestanding, academically affiliated, rehabilitation hospitals were tasked with implementing a cognitive strategy‐based intervention approach that incorporates SDM known as Cognitive Orientation to daily Occupational Performance (CO‐OP) to treat survivors of stroke. At the end of the 4‐month CO‐OP KT implementation support period, 10 clinicians, two from each site, volunteered as CO‐OP site champions. A semi‐structured focus group was conducted with 10 site champions 3 months following the implementation support period. To meet the study objective, an exploratory qualitative research design was used. The focus group session was audio‐recorded, transcribed verbatim and analyzed through the lens of the integrated promoting action on research implementation in health services (iPARIHS) framework. The focus group participants (n = 8) consisted of occupational therapists, physical therapists, and speech language pathologists. Ten recommendations for CO‐OP implementation were extracted and co‐constructed from the focus group transcript. The recommendations reflected all four iPARHIS constructs: Facilitation, Context, Innovation, and Recipients. Implementation recommendations, from the knowledge user perspective, highlight that context‐specific facilitation is key to integrating a novel, complex intervention into interprofessional practice. Facilitators should lay out a framework for training, communication and implementation that is structured but still provides flexibility for iterative learning and active problem‐solving within the relevant practice context.

BackgroundThe Cognitive Orientation to daily Occupational Performance (CO-OP) approach is a complex rehabilitation intervention in which clients are taught to use problem-solving cognitive strategies to acquire personally-meaningful functional skills, and health care providers are required to shift control regarding treatment goals and intervention strategies to their clients. A multi-faceted, supported, knowledge translation (KT) initiative was targeted at the implementation of CO-OP in inpatient stroke rehabilitation teams at five freestanding rehabilitation hospitals. The study objective was to estimate changes in rehabilitation clinicians’ knowledge, self-efficacy, and practice related to implementing CO-OP.MethodsA single arm pre-post and 6-month follow up study was conducted. CO-OP KT consisted of a 2-day workshop, 4 months of implementation support, a consolidation session, and infrastructure support. In addition, a sustainability plan was implemented. Consistent with CO-OP principles, teams were given control over specific implementation goals and strategies. Multiple choice questions (MCQ) were used to assess knowledge. A self-efficacy questionnaire with 3 subscales (Promoting Cognitive Strategy Use, PCSU; Client-Focused Therapy, CFT; Top-Down Assessment and Treatment, TDAT) was developed for the study. Medical record audits were used to investigate practice change. Data analysis for knowledge and self-efficacy utilized mixed effects models. Medical record audits were analyzed with frequency counts and chi-squares.ResultsSixty-five health care providers consisting mainly of occupational and physical therapists entered the study. Mixed effects models revealed intervention effects for MCQs, CFT, and PCSU at post intervention and follow-up, but no effect on TDAT. No charts showed any evidence of CO-OP use at baseline, compared to 8/40 (20%) post intervention. Post intervention there was a trend towards reduction in impairment goals and significantly more component goals were set (z = 2.7, p = .007).

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The objective of this project was to examine the feasibility and preliminary outcomes of an evidence-based cognitive augmented mobility program (CAMP) for persons with stroke. Relevance• Current mobility treatment approaches for survivors of stroke are not usually associated with improved community participation, transfer of skills learned in therapy to new skills, nor skill maintenance 1,2 • A potential solution may be to combine the best practices for improving walking and mobility in persons with stroke with cognitive strategy training to improve problem solving, confidence, maintenance and transfer of skills to the community • Best evidence suggests therapists should incorporate task-specific training, aerobics, and strengthening to improve mobility in gait in persons with stroke • Related research suggests that incorporating cognitive problem-solving strategy training may lead to better skill maintenance and transfer 3,4 Methods Analysis: Due to the small sample size, non-parametric statistics were used. Medians and ranges were calculated, and to estimate efficacy, differences between assessment points were analyzed using Wilcoxon test and non-parametric effect size r was calculated and were are coded as small (.1), medium (.3) or large (.5) effects. 3 Additionally, for measures for which an estimate of a minimally important change was available, the proportion of participants who achieved that level was calculated and reported.Two groups of 4 participants post stroke, post usual care, with mobility goals, able to walk at least 3 metres, and able to follow directions. Analysis & Results Discussion & Conclusion• The positive results included a large effect on self-selected goal performance at one-month follow-up and transfer of learning to balance and mobility skills • Findings suggest CAMP is feasible, and, that there is a potential complementary effect in combining best evidence for mobility and fitness for persons with stroke with cognitive strategy training that warrants further investigation • These results may be a precursor to future discussions exploring methods to include active problem-solving & shared-decision making throughout care