Monday, January 25, 2021

Implementation of evidence-based assessment of the upper extremities in stroke rehabilitation: From evidence to clinical practice

What the fuck stupidity is this? 'Assessment' NOT evidence based results based upon EXACT  stroke protocols. 

Implementation of evidence-based assessment of the upper extremities in stroke rehabilitation: From evidence to clinical practice

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Journal of Rehabilitation Medicine, 19 Jan 2021,
DOI: 10.2340/16501977-2790 PMID: 33470413 

Abstract 

Objective

There is an evidence-practice gap in assessment of the upper extremities during acute and subacute stroke rehabilitation. The aim of this study was to target this gap by describing and evaluating the implementation of, and adherence to, an evidence-based clinical practice guideline for occupational therapists and physiotherapists.

Methods

The upper extremity assessment implementation process at Sahlgrenska University Hospital comprised 5 stages: mapping clinical practice, identifying evidence-based outcome measures, development of a guideline, implementation, and evaluation. A systematic theoretical framework was used to guide and facilitate the implementation process.

Results

The guideline includes 6 primary standardized assessments (Shoulder Abduction, Finger Extension (SAFE), 2 items of the Actions Research Arm Test (ARAT-2), Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Box and Block Test (BBT), 9-Hole Peg Test (9HPT), and grip strength) performed at specified time-points post-stroke. More than 80% of clinicians (n = 44) reported being content with the guideline and the implementation work. Approximately 60-90% of the clinicians reported good adherence to specific assessments, and approximately 50% reported good adherence to the agreed time-points. Comprehensive scales were more difficult to implement compared with short. High levels of work rotation among staff, and the need to prioritize other assessments during the first week after stroke, hindered adherence.

Conclusion

The robustness of evidence, adequate support and receptive context facilitated implementation. The guideline enables a more structured, knowledge-based and equal assessment, and thereby supports clinical decision-making and patient involvement.

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