Implementing a function-based cognitive strategy intervention within inter-professional stroke rehabilitation teams: Changes in provider knowledge, self-efficacy and practice

Once again the stroke survivor is responsible for every piece of their recovery, their doctor is doing nothing. 

Implementing a function-based cognitive strategy intervention within inter-professional stroke rehabilitation teams: Changes in provider knowledge, self-efficacy and practice

• Sara E. McEwen ,
• Michelle Donald,
• Katelyn Jutzi,
• Kay-Ann Allen,
• Lisa Avery,
• Deirdre R. Dawson,
• Mary Egan,
• Katherine Dittmann,
• Anne Hunt,
• Jennifer Hutter,
• Sylvia Quant,
• Jorge Rios,
• Elizabeth Linkewich

• Published: March 11, 2019
• https://doi.org/10.1371/journal.pone.0212988

• Article
• Authors
• Metrics
• Comments
• Media Coverage

• Abstract
• Introduction
• Methods
• Results
• Discussion
• Conclusion
• Supporting information
• Acknowledgments
• References

• Reader Comments (0)
• Media Coverage (0)
• Figures

Abstract

Background

The Cognitive Orientation to daily Occupational Performance (CO-OP) approach is a complex rehabilitation intervention in which clients are taught to use problem-solving cognitive strategies to acquire personally-meaningful functional skills, and health care providers are required to shift control regarding treatment goals and intervention strategies to their clients. A multi-faceted, supported, knowledge translation (KT) initiative was targeted at the implementation of CO-OP in inpatient stroke rehabilitation teams at five freestanding rehabilitation hospitals. The study objective was to estimate changes in rehabilitation clinicians’ knowledge, self-efficacy, and practice related to implementing CO-OP.

Methods

A single arm pre-post and 6-month follow up study was conducted. CO-OP KT consisted of a 2-day workshop, 4 months of implementation support, a consolidation session, and infrastructure support. In addition, a sustainability plan was implemented. Consistent with CO-OP principles, teams were given control over specific implementation goals and strategies. Multiple choice questions (MCQ) were used to assess knowledge. A self-efficacy questionnaire with 3 subscales (Promoting Cognitive Strategy Use, PCSU; Client-Focused Therapy, CFT; Top-Down Assessment and Treatment, TDAT) was developed for the study. Medical record audits were used to investigate practice change. Data analysis for knowledge and self-efficacy utilized mixed effects models. Medical record audits were analyzed with frequency counts and chi-squares.

Results

Sixty-five health care providers consisting mainly of occupational and physical therapists entered the study. Mixed effects models revealed intervention effects for MCQs, CFT, and PCSU at post intervention and follow-up, but no effect on TDAT. No charts showed any evidence of CO-OP use at baseline, compared to 8/40 (20%) post intervention. Post intervention there was a trend towards reduction in impairment goals and significantly more component goals were set (z = 2.7, p = .007).

Figures