A multi-faceted knowledge translation approach to support persons with stroke and cognitive impairment: evaluation protocol

Implementation Science

Elizabeth Linkewich¹  Sharron Runions¹  Sylvia Quant¹  Anne Hunt³  Mary Y Egan⁴  Deirdre Dawson²  Michelle Donald¹  Sara E McEwen⁵ 

[1] Sunnybrook Health Sciences Centre, Toronto, Canada;Rotman Research Institute, Baycrest, Toronto, Canada;Bloorview Research Institute and Holland Bloorview Kids Rehab Hospital, Toronto, Canada;University of Ottawa, Ottawa, Canada;University of Toronto, Toronto, Canada

关键词: Protocol;    Interrupted time series;    Knowledge translation;    Rehabilitation;    Cognitive impairment;    Stroke;    Cognitive orientation to daily occupational performance;   

Others  :  1230922
DOI  :  10.1186/s13012-015-0346-6

 received in 2015-10-15, accepted in 2015-10-29,  发布年份 2015

【 摘 要 】

Background

Patients with cognitive impairments following a stroke are often denied access to inpatient rehabilitation. The few patients with cognitive impairment admitted to rehabilitation generally receive services based on outdated impairment-reduction models, rather than recommended function-based approaches. Both reduced access to rehabilitation and the knowledge-to-practice gap stem from a reported lack of skills and knowledge regarding cognitive rehabilitation on the part of inpatient rehabilitation team members. To address these issues, a multi-faceted knowledge translation (KT) initiative will be implemented and evaluated. It will be targeted specifically at the inter-professional application of the cognitive orientation to daily occupational performance (CO-OP). CO-OP training combined with KT support is called CO-OP KT. The long-term objective of CO-OP KT is to optimize functional outcomes for individuals with stroke and cognitive impairments. Three research questions are posed:

1. Is the implementation of CO-OP KT associated with a change in the proportion of patients with cognitive impairment following a stroke accepted to inpatient rehabilitation?

2. Is the implementation of CO-OP KT associated with a change in rehabilitation clinicians’ practice, knowledge, and self-efficacy related to implementing the CO-OP approach, immediately following and 1 year later?

3. Is CO-OP KT associated with changes in activity, participation, and self-efficacy to perform daily activities in patients with cognitive impairment following stroke at discharge from inpatient rehabilitation and at 1-, 3-, and 6-month follow-ups?

Methods/Design

Three interrelated studies will be conducted. Study 1 will be a quasi-experimental, interrupted time series design measuring monthly summaries of stroke unit level data. Study 2, which relates to changes in health care professional practice and self-efficacy, will be a single group pre-post evaluation design incorporating chart audits and a self-report survey. Study 3 will assess patient functional outcomes using a non-randomized design with historical controls. Assessments will occur during admission and discharge from rehabilitation and at 1, 3, and 6 months following discharge from rehabilitation.

Discussion

This project will advance knowledge about the degree to which the implementation of a supported KT initiative can sustainably change health system, knowledge, and patient outcomes.

【 授权许可】

   
2015 McEwen et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

【 参考文献 】

• [1]Sharp S, Linkewich E, Willems J, Tahair N, Levy C, Bayley M. What should really be happening to our stroke patients post-acute care? A system best practice model for inpatient rehab [abstract]. Stroke. 2014; 45:ATP259.
• [2]Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas M, Felicetti T, Laatsch L, Harley JP, Bergquist T, Azulay J, Cantor J, Ashman T. Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch Phys Med Rehabil. 2011; 92(4):519-30.
• [3]Melkas S, Jokinen H, Hietanen M, Erkinjuntti T. Poststroke cognitive impairment and dementia: prevalence, diagnosis, and treatment. Degener Neurol Neuromuscul Dis. 2014; 4:21-7.
• [4]Linkewich E. Cognitive rehab: a grounding in what is and what could be. 2014.
• [5]Polatajko HJ, Mandich A. Enabling occupation in children: the cognitive orientation to daily occupational performance (CO-OP) approach: first edition ed. CAOT Publications ACE, Ottawa; 2004.
• [6]Eskes G. Mood and cognition in patients following stroke. Canadian stroke best practice recommendations. 4th ed. Lindsay MP, Gubitz G, Bayley M, Phillips S, editors. Canadian Stroke Network, Ottawa; 2013.
• [7]Toronto Stroke Networks. http://www.tostroke.com (2013). Accessed October 13, 2015.
• [8]Ankolekar S, Renton C, Sare G, Ellender S, Sprigg N, Wardlaw JM, Bath PM. Relationship between poststroke cognition, baseline factors, and functional outcome: data from “efficacy of nitric oxide in stroke” trial. J Stroke Cerebrovasc Dis. 2014; 23(7):1821-9.
• [9]Quality-based procedures clinical handbook for stroke. 2013.
• [10]McEwen SE, Polatajko HJ, Huijbregts MP, Ryan JD. Exploring a cognitive-based treatment approach to improve motor-based skill performance in chronic stroke: results of three single case experiments. Brain Inj. 2009; 23(13–14):1041-53.
• [11]McEwen SE, Polatajko HJ, Huijbregts MPJ, Ryan JD. Inter-task transfer of meaningful, functional skills following a cognitive-based treatment: results of three multiple baseline design experiments in adults with chronic stroke. Neuropsychol Rehabil. 2010; 20(4):541-61.
• [12]McEwen S, Polatajko H, Baum C, Rios J, Cirone D, Doherty M, Wolf T. Combined cognitive-strategy and task-specific training improve transfer to untrained activities in subacute stroke: an exploratory randomized controlled trial. Neurorehabil Neural Repair. 2015; 29(6):526-36.
• [13]Skidmore ER, Holm MB, Whyte EM, Dew MA, Dawson D, Becker JT. The feasibility of meta-cognitive strategy training in acute inpatient stroke rehabilitation: case report. Neuropsychol Rehabil. 2011; 21(2):208-23.
• [14]Skidmore ER, Dawson DR, Whyte EM, Butters MA, Dew MA, Grattan ES, Becker JT, Holm MB. Developing complex interventions: lessons learned from a pilot study examining strategy training in acute stroke rehabilitation. Clin Rehabil. 2014; 28(4):378-87.
• [15]Polatajko HJ, McEwen SE, Ryan JD, Baum CM. Pilot randomized controlled trial investigating cognitive strategy use to improve goal performance after stroke. Am J Occup Ther. 2012; 66(1):104-9.
• [16]Law M, Babtiste S, Carswell A, McColl MA, Polatajko H, Pollock N. Canadian occupational performance measure. 5th ed. CAOT Publications ACE, Ottawa; 2014.
• [17]Davis D, Evans M, Jadad A, Perrier L, Rath D, Ryan D, Sibbald G, Straus S, Rappolt S, Wowk M, Zwarenstein M. The case for knowledge translation: shortening the journey from evidence to effect. BMJ. 2003; 327(7405):33-5.
• [18]Knowledge translation initiatives using a systems approach. McMaster University, Hamilton; 2013.
• [19]Kitson AL. The need for systems change: reflections on knowledge translation and organizational change. J Adv Nurs. 2009; 65(1):217-28.
• [20]Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006; 26(1):13-24.
• [21]A national interprofessional competency framework. 2010.
• [22]Dawson DR, Gaya A, Hunt A, Levine B, Lemsky C, Polatajko HJ. Using the cognitive orientation to occupational performance (CO-OP) with adults with executive dysfunction following traumatic brain injury. Can J Occup Ther. 2009; 76(2):115-27.
• [23]Henshaw E, Polatajko H, McEwen S, Ryan JD, Baum CM. Cognitive approach to improving participation after stroke: two case studies. Am J Occup Ther. 2011; 65(1):55-63.
• [24]Penfold RB, Zhang F. Use of interrupted time series analysis in evaluating health care quality improvements. Acad Pediatr. 2013; 13(6 Suppl):S38-44.
• [25]Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil. 1987;1:6-18.
• [26]Foy R, Eccles MP. Audit and feedback interventions. Knowledge translation in health care: moving from evidence to practice. Straus SE, Tetroe J, Graham ID, editors. John Wiley & Sons, Ltd, Chichester; 2013.
• [27]Korner-Bitensky N, Wood-Dauphinee S, Siemiatycki J, Shapiro S, Becker R. Health-related information postdischarge: telephone versus face-to-face interviewing. Arch Phys Med Rehabil. 1994; 75(12):1287-96.
• [28]Segal ME, Schall RR. Determining functional/health status and its relation to disability in stroke survivors. Stroke. 1994; 25(12):2391-7.
• [29]Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(4):695-9.
• [30]StatsToDo. Computer Program to Calculate Sample Requirement to Compare 2 Proportions. https://www.statstodo.com/SSiz2Props_Pgm.php. Accessed October 13, 2015.
• [31]Borckardt JJ, Nash MR, Murphy MD, Moore M, O’Neil P. Clinical practice as natural laboratory for psychotherapy research. Am Psychol. 2008; 63(2):77-95.
• [32]Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15(9):1277-88.
• [33]Blanton S, Morris DM, Prettyman MG, McCulloch K, Redmond S, Light KE, Wolf SL. Lessons learned in participant recruitment and retention: the EXCITE trial. Phys Ther. 2006; 86(11):1520-33.
• [34]Cup EH, Scholte op Reimer WJ, Thijssen MC, van Kuyk-Minis MA. Reliability and validity of the Canadian occupational performance measure in stroke patients. Clin Rehabil. 2003; 17(4):402-9.
• [35]Gage M, Noh S, Polatajko HJ, Kaspar V. Measuring perceived self-efficacy in occupational therapy. Am J Occup Ther. 1994; 48(9):783-90.
• [36]Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ. The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. Stroke. 1999; 30(10):2131-40.
• [37]Duncan PW, Bode RK, Min Lai S, Perera S. Rasch analysis of a new stroke-specific outcome scale: the stroke impact scale. Arch Phys Med Rehabil. 2003; 84(7):950-63.
• [38]Edwards B, O’Connell B. Internal consistency and validity of the stroke impact scale 2.0 (SIS 2.0) and SIS-16 in an Australian sample. Qual Life Res. 2003; 12(8):1127-35.