Development, Implementation, and Clinician Adherence to a Standardized Assessment Toolkit for Sensorimotor Rehabilitation after Stroke

Richards, Carol L.; Malouin, Francine; Nadeau, Sylvie; Fung, Joyce; D'Amours, Line; Pérez, Claire; Durand, Anne

doi:10.3138/ptc.2017-41

Cited by 11 publications

(7 citation statements)

References 38 publications

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“…Predictors are most often assessed with standardized outcome measures, and from implementation research on stroke assessments ( 34 ), it is known that the willingness and ability to change are additionally hampered by the lack of familiarity with the assessments ( 31 , 34 ), having difficulty with changing routines ( 34 ), time and equipment needed to perform assessments ( 31 , 34 ), and the lack of support from the management staff or team members ( 31 ). Whether the assessment is performed is highly dependent on the inability of a patient to participate in the testing due to, for example, communication or cognitive deficits ( 31 , 35 ). Based on the available implementation literature, an approach to implement the EPOS model for independent gait would be initiated by therapists themselves, having support from the management staff, having a close collaboration between researchers who developed the model and clinicians, providing ongoing education and ‘teaching on the job,' and having directions on important treatment foci ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

External Validation of the Early Prediction of Functional Outcome After Stroke Prediction Model for Independent Gait at 3 Months After Stroke

et al. 2022

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IntroductionThe Early Prediction of Functional Outcome after Stroke (EPOS) model for independent gait is a tool to predict between days 2 and 9 poststroke whether patients will regain independent gait 6 months after stroke. External validation of the model is important to determine its clinical applicability and generalizability by testing its performance in an independent cohort. Therefore, this study aimed to perform a temporal and geographical external validation of the EPOS prediction model for independent gait after stroke but with the endpoint being 3 months instead of the original 6 months poststroke.MethodsTwo prospective longitudinal cohort studies consisting of patients with first-ever stroke admitted to a Swiss hospital stroke unit. Sitting balance and strength of the paretic leg were tested at days 1 and 8 post-stroke in Cohort I and at days 3 and 9 in Cohort II. Independent gait was assessed 3 months after symptom onset. The performance of the model in terms of discrimination (area under the receiver operator characteristic (ROC) curve; AUC), classification, and calibration was assessed.ResultsIn Cohort I [N = 39, median age: 74 years, 33% women, median National Institutes of Health Stroke Scale (NIHSS) 9], the AUC (95% confidence interval (CI)] was 0.675 (0.510, 0.841) on day 1 and 0.921 (0.811, 1.000) on day 8. For Cohort II (N = 78, median age: 69 years, 37% women, median NIHSS 8), this was 0.801 (0.684, 0.918) on day 3 and 0.846 (0.741, 0.951) on day 9.Discussion and ConclusionExternal validation of the EPOS prediction model for independent gait 3 months after stroke resulted in an acceptable performance from day 3 onward in mild-to-moderately affected patients with first-ever stroke without severe prestroke disability. The impact of applying this model in clinical practice should be investigated within this subgroup of patients with stroke. To improve the generalizability of patients with recurrent stroke and those with more severe, neurological comorbidities, the performance of the EPOS model within these patients should be determined across different geographical areas.

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Section: Discussionmentioning

confidence: 99%

External Validation of the Early Prediction of Functional Outcome After Stroke Prediction Model for Independent Gait at 3 Months After Stroke

et al. 2022

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“…Knowledge translation interventions designed to facilitate guideline implementation in stroke rehabilitation to date have been costly, requiring funds to support and train local clinical facilitators or clinicians to enable practice change [14,[18][19][20]. Interventions have also targeted the implementation of multiple recommended practices simultaneously [14,19,21], making it challenging for stroke teams to prioritize practices [22].…”

Section: Introductionmentioning

confidence: 99%

“…None of the studies included in this review described toolkits targeting rehabilitation professionals or healthcare services for people post-stroke [23]. Nonetheless, individual tools [20] or toolkits [14,21] have been previously included in multi-component knowledge translation interventions targeting the implementation of best practices in stroke rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

The role of theory to develop and evaluate a toolkit to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke

Salbach

MacKay-Lyons

Solomon

et al. 2021

Disability and Rehabilitation

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Purpose: The iWalk study showed that 10-meter walk test (10mWT) and 6-minute walk test (6MWT) administration post-stroke increased among physical therapists (PTs) following introduction of a toolkit comprising an educational guide, mobile app, and video. We describe the use of theory guiding toolkit development and a process evaluation. Materials and methods: We used the knowledge-to-action framework to identify research steps; and a guideline implementability framework, self-efficacy theory, and the transtheoretical model to design and evaluate the toolkit and implementation process (three learning sessions). In a before-and-after study, 37 of the 49 participating PTs completed online questionnaires to evaluate engagement with learning sessions, and rate self-efficacy to perform recommended practices pre-and post-intervention. Thirty-three PTs and 7 professional leaders participated in post-intervention focus groups and interviews, respectively. Results: All sites conducted learning sessions; attendance was 50-78%. Self-efficacy ratings for recommended practices increased and were significant for the 10mWT (p 0.004). Qualitative findings highlighted that theory-based toolkit features and implementation strategies likely facilitated engagement with toolkit components, contributing to observed improvements in PTs' knowledge, attitudes, skill, selfefficacy, and clinical practice. Conclusions: The approach may help to inform toolkit development to advance other rehabilitation practices of similar complexity. ä IMPLICATIONS FOR REHABILITATIONToolkits are an emerging knowledge translation intervention used to support widespread implementation of clinical practice guideline recommendations. Although experts recommend using theory to inform the development of knowledge translation interventions, there is little guidance on a suitable approach. This study describes an approach to using theories, models and frameworks to design a toolkit and implementation strategy, and a process evaluation of toolkit implementation. Theory-based features of the toolkit and implementation strategy may have facilitated toolkit implementation and practice change to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke.

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“…In contrast, more than 60% of the participants in our study treated people suffering from neurological and neurodegenerative disorders or worked in geriatrics assisting elderly people at risk of chronic disease or disability. In this respect, it is recognised that the field of neurology is an area where cognitive, physical, and functional aspects are assessed to a greater extent [ 28 , 29 ]. This may explain why functional assessments and instruments for measuring cognitive or motor impairment were reported in higher proportions by the occupational therapists who participated in our study.…”

Section: Discussionmentioning

confidence: 99%

Identification and Use of Assessment Tools in Spanish Occupational Therapists: An Exploratory Study

et al. 2022

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The use of standardized assessment tools is essential for the occupational therapy intervention process to ensure clinical practice is appropriate and of high quality. This study aimed to explore which assessment tools Spanish occupational therapists use in their clinical practice. An ad hoc online questionnaire of 19 open and closed questions was used to collect information on assessment tools, socio-demographics, and academic background. The assessment tools were classified according to the main domains of occupational therapy using the last edition of the American Occupational Therapy Association framework. The survey was completed by 73 Spanish occupational therapists, of whom 86.3% were women; the median age was 31 years, and more than 60% treated people suffering from neurological and neurodegenerative disorders or worked in geriatric medicine. Of 147 assessment tools identified, those designed to assess activities of daily living, body functions, process skills, and motor skills were the instruments most frequently used. Specifically, the Barthel Index, Lawton Instrumental ADL Scale, Functional Independence Measure, Sensory Profile 2, and Mini-Examen Cognoscitivo were the tools most employed by Spanish occupational therapists. However, more than one third of the participants used assessment tools without knowing whether they were validated in the Spanish context and/or a specific target population. To our knowledge, this is the first time a study has examined the use and type of assessment tools in Spanish occupational therapists. Our results may constitute a positive step forward for developing strategies for enhancing evidence-based assessment in occupational therapy practice.

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Development, Implementation, and Clinician Adherence to a Standardized Assessment Toolkit for Sensorimotor Rehabilitation after Stroke

Cited by 11 publications

References 38 publications

External Validation of the Early Prediction of Functional Outcome After Stroke Prediction Model for Independent Gait at 3 Months After Stroke

External Validation of the Early Prediction of Functional Outcome After Stroke Prediction Model for Independent Gait at 3 Months After Stroke

The role of theory to develop and evaluate a toolkit to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke

Identification and Use of Assessment Tools in Spanish Occupational Therapists: An Exploratory Study

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