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

Until you get to a protocol, stuff like this is worthless.  You need a protocol with exact steps mapped to an objective diagnosis that will deliver an x% efficacy. Until that occurs stroke survivors will continue to be one person stroke research subjects as unregulated guinea pigs.

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

Carol L. Richards , BScPT, PhDRelated information

*Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City;

†Centre interdisciplinaire de recherche en réadaptation et intégration sociale;

‡Département de réadaptation, Université Laval, Laval, Que.

; Francine Malouin , BScPT, PhDRelated information

*Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City;

†Centre interdisciplinaire de recherche en réadaptation et intégration sociale;

‡Département de réadaptation, Université Laval, Laval, Que.

; Sylvie Nadeau , BScPT, PhDRelated information

§Institut de réadaptation Gingras-Lindsay de Montréal, CIUSSS Centre-Sud-de-l’Île-de-Montréal;

¶Centre interdisciplinaire de recherche en réadaptation;

**École de réadaptation, Université de Montréal;

; Joyce Fung , BScPT, PhDRelated information

¶Centre interdisciplinaire de recherche en réadaptation;

††Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval;

‡‡School of Physical and Occupational Therapy, McGill University, Montreal;

; Line D’Amours , BScOT, MBARelated information

*Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City;

; Claire Perez , BScPT, MScRelated information

¶Centre interdisciplinaire de recherche en réadaptation;

††Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval;

‡‡School of Physical and Occupational Therapy, McGill University, Montreal;

; Anne Durand , BScPT, PhDRelated information

*Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City;

From the:

*Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City;

§Institut de réadaptation Gingras-Lindsay de Montréal, CIUSSS Centre-Sud-de-l’Île-de-Montréal;

¶Centre interdisciplinaire de recherche en réadaptation;

**École de réadaptation, Université de Montréal;

‡‡School of Physical and Occupational Therapy, McGill University, Montreal;

††Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval;

†Centre interdisciplinaire de recherche en réadaptation et intégration sociale;

‡Département de réadaptation, Université Laval, Laval, Que.

Correspondence to: Dr. Carol L. Richards, Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), 525 Boul. Wilfrid-Hamel Est, Québec, QC G1M 2S8; carol.richards@fmed.ulaval.ca.

https://doi.org/10.3138/ptc.2017-41

Published Online: January 04, 2019

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Abstract

Purpose: This study describes the development of a standardized assessment toolkit (SAT) and associated clinical database focusing on sensorimotor rehabilitation in three stroke rehabilitation units (SRUs). Implementation of the SAT was confirmed using objective measures of clinician adherence while exploring reasons for varied adherence.  
Method: Participants were patients post-stroke admitted for inpatient rehabilitation and clinicians from the three SRUs. A collaborative and iterative process was used to develop the SAT. Implementation was measured by clinician adherence, which was charted by means of assessment entries in patient records and transferred to the clinical database. Reasons for lower adherence were interpreted from therapist data logs at one SRU.  
Results: The SAT consisted of 25 assessment tools. Clinician adherence to a subset of the tools ranged from 33% to 99% at admission and from 28% to 94% at discharge. At one site, lower adherence among the tools was explained by patient-related factors (1%–36%) and protocol or logistical reasons (0%–7%) at admission; missing data ranged from 0% to 3%, except for the Montreal Cognitive Assessment (17%).  
Conclusions: In this pragmatic study, objective measures of clinician adherence demonstrated the feasibility of implementing an SAT in daily practice. Moreover, the reasons for lower adherence rates may be related to the patients, protocol, and logistics, all of which may vary with the assessment tool, rather than clinician compliance.