Case Series of a Knowledge Translation Intervention to Increase Upper Limb Exercise in Stroke Rehabilitation

These people are still going down the wrong path; assuming that the rehabilitation silo is the way to improve recovery. WRONG, WRONG, WRONG, You go earlier in the cause and effect cycle and stop the neuronal cascade of death by these 5 causes in the first week.  I really do wonder if any people in stroke have two functioning neurons they can rub together. And they don't even tell us the fucking results. Did the survivors have a better recovery? JEESH! Did these researchers get their hands slapped by our MIA great stroke association president?
http://ptjournal.apta.org/content/early/2016/06/22/ptj.20150694.abstract

Louise A. Connell, Naoimh E. McMahon, Sarah F. Tyson, Caroline L. Watkins, Janice J. Eng

DOI: 10.2522/ptj.20150694 Published June 23, 2016

Louise A. Connell

L.A. Connell, PhD, BSc(Hons)Physiotherapy, College of Health and Wellbeing, University of Central Lancashire, Preston, PR1 2HE United Kingdom.

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Naoimh E. McMahon

N.E. McMahon, MA, BSc(Hons)Physiotherapy, College of Health and Wellbeing, University of Central Lancashire.

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Sarah F. Tyson

S.F. Tyson, PhD, BSc(Hons)Physiotherapy, Stroke and Vascular Research Centre, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom.

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Caroline L. Watkins

C.L. Watkins, PhD, BA(Hons)Psychology, College of Health and Wellbeing, University of Central Lancashire.

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Janice J. Eng

J.J. Eng, PhD, BSc(PT/OT), Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.

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Medium f*cking whoopee.

Abstract

Background and Purpose Current approaches to upper limb rehabilitation are not sufficient to drive neural reorganisation and maximise recovery after stroke. To address this evidence-practice gap we developed a knowledge translation intervention using the Behaviour Change Wheel. The intervention involves collaborative working with stroke therapy teams to change their practice, and increase therapy intensity by therapists prescribing supplementary self-directed arm exercise. The purposes of this case series are: (1) to provide an illustrative example of how a research-informed process changed clinical practice and (2) to report on staff and patients' perceptions (Who gives a shit about perceptions?)of the utility of the developed intervention.

Case Descriptions A participatory action research approach was used in three stroke rehabilitation units in the United Kingdom. The intervention aimed to change four therapist level behaviours: (i) screening patients for suitability for supplementary self-directed arm exercise, (ii) provision of exercises, (iii) involving family/carers in assisting with exercises and (iv) monitoring and progressing exercises. Data on changes in practice were collected by therapy teams using a bespoke audit tool. Utility of the intervention was explored in qualitative interviews with patients and staff.

Outcomes Components of the intervention were successfully embedded in two of the three stroke units. At these sites almost all admitted patients were screened for suitability for supplementary self-directed exercise. 77%, 70% and 88% of suitable patients across the three sites were provided exercises. Involving family/carers, and monitoring and progressing exercises, were not performed consistently.

Conclusions This study is an example of how a rigorous research-informed knowledge translation process resulted in practice change. Further research is needed to demonstrate that these changes can translate into increased intensity of upper limb exercise and affect patient outcomes.

• Received December 24, 2015.
• Accepted May 30, 2016.

• © 2016 American Physical Therapy Association