This to me indicates that the top down approach is completely wrong, you give the survivors the protocols that are out there with efficacy ratings and the survivors give them to the therapists and doctors to implement. Survivors would ensure that they get the protocols they need and if they don't exist the doctors and therapists are in charge of getting them created. The current situation of non-existent stroke protocols is the result of nobody taking charge. Survivors would take charge since their recovery hangs in the balance.
Survivors don't give a fuck about assessments, they want the real thing; PROTOCOLS THAT DELIVER RECOVERY.
Applying the Knowledge-to-Action Framework to Implement Gait and Balance Assessments in Inpatient Stroke Rehabilitation
Published:November 26, 2020DOI:https://doi.org/10.1016/j.apmr.2020.10.133
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Abstract
Objective
The overall objectives of this project were to implement and sustain use of a gait
assessment battery (GAB) that included the Berg Balance Scale, 10 Meter Walk Test,
and 6 Minute Walk Test during inpatient stroke rehabilitation. The study objective
was to assess the impact of the study intervention on clinician adherence to the recommendations
and its impact on clinician perceptions and the organization.
Design
Pre and post-training intervention study.
Setting
Subacute inpatient rehabilitation facility.
Participants
Six Physical therapists and two physical therapist assistants.
Intervention.
The intervention comprised a bundle of activities including co-developing and executing
the plan with clinicians and leaders. The multi-component implementation plan was
based on the Knowledge-to-Action Framework, and included implementation facilitation,
implementation leadership, and a bundle of knowledge translation interventions that
targeted barriers. Implementation was an iterative process in which results from one
implementation phase informed planning of the next phase.
Main Outcome Measures.
Clinician administration adherence, surveys of perceptions, and organizational outcomes.
Results
Initial adherence to the GAB was 46% and increased to >85% after 6 months. These adherence
levels remained consistent 48 months after implementation. Clinician perceptions of
measure use were initially high (>63%), with significant improvements in knowledge
and use of one measure after implementation.
Conclusions
We successfully implemented the assessment battery with high levels of adherence to
recommendations, likely as a consequence of using the bundle of knowledge translation
activities, facilitation, and use of a framework to co-develop the plan. These changes
in practice were sustainable, as determined by a 4-year follow-up.
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