https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0631-7
- Nancy M. SalbachEmail author,
- 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 and
- on behalf of the Stroke Canada Optimization of Rehabilitation By Evidence – Implementation Trial (SCORE-IT) Team
Received: 31 October 2016
Accepted: 24 July 2017
Published: 1 August 2017
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.
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