Implementation Strategies and Outcomes for Occupational Therapy in Adult Stroke Rehabilitation: A Scoping Review

Absolutely nothing here tells me your rehabilitation outcomes. Useless. Did you get any of the patients even minutely close to 100% recovery?

 Implementation Strategies and Outcomes for Occupational Therapy in Adult Stroke Rehabilitation: A Scoping Review

J. Edward Murrell (  ed21@uab.edu )
UAB: University of Alabama at Birmingham https://orcid.org/0000-0002-4204-8075
Janell L. Pisegna
The Ohio State University School of Health and Rehabilitation Sciences
Lisa A. Juckett
The Ohio State University School of Health and Rehabilitation Sciences

J. Edward Murrell, Janell L. Pisegna, Lisa A. Juckett
DOI:
10.21203/rs.3.rs-229354/v1
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Abstract

Background

Every year, millions of people worldwide experience a stroke. Given the degree of physical, cognitive, visual, and behavioral impairments post-stroke, stroke survivors often encounter occupational therapy practitioners in the rehabilitation practice settings. Although evidence-based occupational therapy practices have been well-established in the stroke literature, it remains unclear what strategies have been used to promote these practices' effective implementation in the real-world context. The present review identifies these strategies and the extent to which researchers have measured implementation outcomes.

Methods

A scoping review protocol was developed to assess the breadth and depth of occupational therapy literature examining implementation strategies and outcomes in the stroke rehabilitation field. Four electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer, as needed, to achieve consensus. The Expert Change guided synthesis of review findings for Implementing Change project and the Implementation Outcomes Framework.  

Results

The initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were deployed in the included studies. The most used implementation strategies were “distribute educational materials,” “assess for readiness and identify barriers and facilitators,” and “conduct educational outreach visits.” “Adoption” was the most frequently measured implementation outcome, while “cost” was not measured in any included studies. Eleven studies reported findings to support the effectiveness of their implementation strategy or strategies; eleven studies reported inconclusive findings, and four studies found that their strategies did not lead to improved implementation outcomes.  

Conclusions

This scoping review identified occupational therapy literature examining implementation strategies and outcomes in the context of stroke rehabilitation. With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the uptake of evidence-based practices into routine stroke care. (So you don't even care whether or not your therapies are effective?) Occupational therapy researchers and practitioners are encouraged to collaborate to develop and deploy implementation strategies responsive to known implementation barriers and facilitators in the stroke rehabilitation setting.