A systematic review of interventions to increase the use of standardized outcome measures by rehabilitation professionals

Knowledge Translation Task Force for core measures clinical practice guideline: a short report on the process and utilization

BACKGROUND

As part of the 2018 Clinical Practice Guideline (CPG): A Core Set of Outcome Measures for Adults with Neurologic Conditions Undergoing Rehabilitation, a Knowledge Translation (KT) Task Force was convened. The purpose of this short report was to (1) demonstrate the potential impact of a CPG KT Task Force through a practical example of efforts to implement a CPG into neurologic physical therapy practice and (2) describe the process to convene a KT Task Force and develop products (KT Toolkit) to facilitate implementation of the CPG.

METHODS

To describe the process used by the KT Task Force to develop and review a KT Toolkit for implementation of the CPG.

RESULTS

Utilizing the Knowledge-To-Action Cycle framework, eight tools were developed as part of the KT Toolkit and are available with open access to the public. Findings indicate that the Core Outcome Measures Homepage, which houses the KT Toolkit, has had greater than 70,000 views since its publication.

CONCLUSIONS

This short report serves as an example of the efforts made to implement a CPG into physical therapy practice. The processes to facilitate KT and the tools developed can inform future implementation efforts and underscore the importance of having a KT Task Force to implement a CPG. Moving forward, KT Task Forces should be convened to implement new or revised guidelines.

TRIAL REGISTRATION

N/A.

Representation of child and youth participation within the Unified Medical Language System (UMLS)

PURPOSE

To examine (1) how much participation is represented in the benchmark Unified Medical Language System (UMLS) resource, and (2) to what extent that representation reflects the definition of child and youth participation and/or its related constructs per the family of Participation-Related Constructs framework.

MATERIALS AND METHODS

We searched and analysed UMLS concepts related to the term "participation." Identified UMLS concepts were rated according to their representation of participation (i.e., attendance, involvement, both) as well as participation-related constructs using deductive content analysis.

RESULTS

363 UMLS concepts were identified. Of those, 68 had at least one English definition, resulting in 81 definitions that were further analysed. Results revealed 2 definitions (2/81; 3%; 2/68 UMLS concepts) representing participation "attendance" and 18 definitions (18/81; 22%; 14/68 UMLS concepts) representing participation "involvement." No UMLS concept definition represented both attendance and involvement (i.e., participation). Most of the definitions (11/20; 55%; 9/16 UMLS concepts) representing attendance or involvement also represent a participation-related construct.

CONCLUSION(S)

The representation of participation within the UMLS is limited and poorly aligned with the contemporary definition of child and youth participation. Expanding ontological resources to represent child and youth participation is needed to enable better data analytics that reflect contemporary paediatric rehabilitation practice.

Testing feasibility of relevant outcome measures in an inpatient setting to demonstrate the value of occupational therapy

INTRODUCTION

Measures of participation restrictions in daily life occupations are not typically used and may aid discharge planning and demonstrate the impact of occupational therapy services in inpatient settings. The overall aim of this mixed-methods study was to test the feasibility of relevant outcome measures by (1) investigating which of the three identified measures-the Home Support Needs Assessment, the Personal Care Participation Assessment and Resource Tool, and the Functional Autonomy Measurement System-best identifies meaningful changes in participation restrictions in daily life occupations required for community life; and (2) investigating the acceptability, usefulness, and feasibility of each measure to support inpatient practice.

METHODS

Occupational therapists (n = 3) completed the three measures with patient participants (n = 12) at admission and discharge. Each occupational therapist participated in a semi-structured interview. Outcome measure responses were summarised statistically. Qualitative data were analysed using reflexive thematic analysis.

FINDINGS

Total scores on all three measures changed significantly between admission and discharge (P < 0.002). Three themes reflected the occupational therapist participants' perceptions of the acceptability, usefulness, and feasibility of the outcome measures: 'Clinically and Professionally Meaningful Tools', 'Becoming Familiar', and 'Fostering My Daily Work'.

CONCLUSION

Each measure demonstrated a meaningful change. Selection and successful implementation of an outcome measure depends on its local acceptability to occupational therapists and organisational practices. All three measures are promising tools to address a measurement gap in occupational therapy practice. Future research could embed one measure into practice using knowledge translation methods, with a large-scale evaluation of the value of occupational therapy.

Scar massage as an intervention for post-surgical scars: A practice survey of Australian hand therapists

Introduction

Scar massage is a commonly used treatment in hand therapy. The current empirical evidence that supports it is disparate and of variable quality, with no established effective dosage and method proposed. This study aimed to identify the current practice among Australian hand therapists using massage as an intervention for scarring following surgery to the hand and upper limb.

Methods

A purposely designed self-report online survey was emailed to current members of the Australian Hand Therapy Association (n = 958). Data collected included demographics, intervention techniques, conditions treated and protocols, scar assessment and knowledge and training about scar massage as a clinical intervention.

Results

A total of 116 completed questionnaires were received (a response rate of 12.1%). All respondents used scar massage as part of their clinical practice with 98% to improve soft tissue glide (n = 114), 92% for hypersensitivity (n = 107), and 84% to increase hand function (n = 97). Only 18% (n = 21) of respondents used standardised outcome measures, and most therapists had learned scar massage from a colleague (81%).

Conclusions

Commonalities in how respondents implemented scar massage were found. Participants reported relying primarily on clinical experience to inform their practice. Whilst scar massage was widely used, few respondents had received formal skills training or completed outcome measures regularly to formally evaluate its clinical efficacy or impact. Replication of this study with a larger international sample of participants is warranted to determine if these findings reflect general practice.

Physical and occupational therapists' perceptions of sustainability of a knowledge translation intervention to improve the use of outcome measures in inpatient rehabilitation: a qualitative study

PURPOSE

To assess the perceptions, barriers, and facilitators of sustaining the use of outcome measures of physical and occupational therapists following a three-year knowledge translation intervention.

METHODS

A phenomenological qualitative study was conducted at an inpatient rehabilitation hospital on 13 clinicians (6 physical therapists and 7 occupational therapists) participating in the knowledge translation intervention. Data collection used semi-structured interviewing during three focus groups to understand the lived experience of clinicians participating in the knowledge translation project. Data were analyzed using the Consolidated Framework for Implementation Research (CFIR) codebook.

RESULTS

Two investigators coded twelve CFIR constructs into barriers and facilitators for outcome measure use. Four key themes emerged as determinants for outcome measures use: (1) Organizational support and clinician engagement; (2) the knowledge translation intervention; (3) the outcome measures themselves; and (4) the patients. Clinicians reported using outcome measures for patient education, treatment planning, and goal setting, while they found other outcome measures lacked functional significance. Facilitators included organizational support, access to knowledge, ongoing training, and clinician engagement. Ongoing barriers included the need for more training and the need to select different tests.

CONCLUSIONS

This study found proper selection of outcomes measures is important and attributed the sustainability of the knowledge translation intervention to organizational support, clinician engagement and ongoing training. The clinicians wanted continued training to overcome new barriers. Barriers identified in this study were unique to the typical barriers identified for outcome measure use. Ongoing barrier assessments are needed for continued refinement of knowledge translation interventions to enhance sustainability.

Use of standardised outcome measures among physiotherapists in French-speaking sub-Saharan Africa

Background

The use of standardised assessment tools is a fundamental aspect of good clinical practice. However, to our knowledge, no study has documented the use of standardised assessment tools in physiotherapy in French-speaking sub-Saharan Africa.

Objectives

Documenting the use of standardised outcome measures in physiotherapy in French-speaking sub-Saharan Africa.

Method

Our cross-sectional survey used an online self-questionnaire on facilitators and barriers to the use of standardised outcome measures, distributed to physiotherapists in French-speaking sub-Saharan Africa.

Results

A total of 241 physiotherapists working in French-speaking sub-Saharan Africa responded to the survey. The most represented countries were Benin (36.9%), Cameroon (14.1%), and Burkina Faso (10.8%). Although 99% of participants reported using standardised outcome measures, only 27% of the respondents used them systematically (all the time). The most reported facilitators included the recognition that standardised outcome measures help to determine whether treatment is effective, help to guide care, and improve communication with patients. The most significant barriers were the lack of time, unavailability of the standardised outcome measures, and non-sensitivity of measures to patients' cultural and ethnic concerns. There was a higher proportion of use in the middle age group (30-40) (p = 0.02) and a lower proportion of use in physiotherapists simultaneously working in public and private sectors (p = 0.05).

Conclusion

Standardised outcome measures are still not widely used by physiotherapists in French-speaking sub-Saharan Africa.

Clinical implications

The perceived barriers and facilitators could help to develop strategies to improve the systematic use of outcome measures in French-speaking sub-Saharan Africa.

Barriers and facilitators to implementation of outcome measures among physiotherapists in Nepal: A mixed-methods study

BACKGROUND

Standardised outcome measures are essential to evidence-based practice but their implementation remains a significant challenge in low- and middle-income countries. The barriers and enablers for implementation of outcome measures are likely different in these settings.

OBJECTIVES

We sought to understand barriers and facilitators to use of standardised outcome measures (e.g. patient-reported, performance-based, clinician-reported) in clinical practice among physiotherapists in Nepal.

DESIGN

Exploratory sequential mixed-method study.

METHODS

We conducted focus groups with physiotherapists in Nepal to understand factors contributing to standardised outcome measure use/non-use in depth and thematically analysed the data using Consolidated Framework for Implementation Research (CFIR). To triangulate the findings, we used an online survey which was distributed to practicing physiotherapists in Nepal using social media.

RESULTS

We interviewed 26 physiotherapists for the qualitative phase and 125 physiotherapists responded to our online survey. The most endorsed facilitator was mandating outcome measure use through regulations at organisational or national level, for example, submission of patient-level outcome measures to an insurance system. Major barriers were lack of time, lack of outcome measures in local languages, inability to follow-up with patients and perceived inability of patients to understand outcome measures. Challenges that had not yet been identified in previous studies were inability to follow-up with patients and organisational culture (e.g., cultural hierarchy within an institution).

CONCLUSION

The findings of our study provide an understanding of the contextual needs, and potential way forward for implementation of outcome measures in developing countries like Nepal. Future studies should focus on establishing consensus on which measures to use, the cross-cultural adaptation of these measures, and developing pathways for regulation.

Evaluating the implementation of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) in three rehabilitation settings in Quebec: a mixed-methods study protocol

INTRODUCTION

Stroke is a leading cause of morbidity and mortality worldwide, placing an immense burden on patients and the health system. Timely access to rehabilitation services can improve stroke survivors' quality of life. The use of standardised outcome measures is endorsed for optimising patient rehabilitation outcomes and improving clinical decision-making. This project results from a provincially mandated recommendation to use the fourth version of the Mayo-Portland Adaptability Inventory (MPAI-4) to measure changes in social participation of stroke survivors and to maintain commitment to evidence-informed practices in stroke care. This protocol outlines the implementation process of the MPAI-4 for three rehabilitation centres. The objectives are to: (a) describe the context of MPAI-4 implementation; (b) determine clinical teams' readiness for change; (c) identify barriers and enablers to implementing the MPAI-4 and match the implementation strategies; (d) evaluate the MPAI-4 implementation outcomes including the degree of integration of the MPAI-4 into clinical practice and (e) explore participants' experiences using the MPAI-4.

METHODS AND ANALYSIS

We will use a multiple case study design within an integrated knowledge translation (iKT) approach with active engagement from key informants. Each case is a rehabilitation centre implementing MPAI-4. We will collect data from clinicians and programme managers using mixed methods guided by several theoretical frameworks. Data sources include surveys, focus groups and patient charts. We will conduct descriptive, correlational and content analyses. Ultimately, we will analyse, integrate data from qualitative and quantitative components and report them within and across participating sites. Results will provide insights about iKT within stroke rehabilitation settings that could be applied to future research projects.

ETHICS AND DISSEMINATION

The project received Institutional Review Board approval from the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal. We will disseminate results in peer-reviewed publications and at local, national and international scientific conferences.

Implementing the language comprehension test C-BiLLT: a qualitative description study using the COM-B model of behaviour change

Background

It is challenging to reliably assess the language comprehension of children with severe motor and speech impairments using traditional assessment tools. The Computer Based instrument for Low motor Language Testing (C-BiLLT) aims to reduce barriers to evidence-based assessment for this population by allowing children to access the test using non-traditional methods such as eye gaze so they can independently respond to test items. The purpose of this study is to develop a contextualized understanding of the factors that influenced clinicians’ implementation of the C-BILLT in practice in the Netherlands and Norway.

Materials and methods

A qualitative approach including semi-structured individual interviews with 15 clinicians (speech-language pathologists, neuropsychologists, and one teacher, counsellor, and vision specialist) was used. Data analysis was conducted in two rounds. First, a deductive approach including a codebook was used to code data within the COM-B components describing clinicians’ capability, opportunity, and motivation for behaviour change. Then, an abductive approach applying thematic analysis was used to identify meaningful patterns within the COM-B components.

Results

Several meaningful barriers and facilitators were identified across the data. Clinicians used the C-BiLLT with two distinct groups of clients: (1) the population it was originally developed for, and (2) clients that could have also been assessed using a traditional language test. Clinicians working with the first group experienced more, and more complex barriers across all COM-B components, to successful C-BiLLT use than the latter.

Conclusion

This study provides timely insights into the capability, opportunity, and motivation factors important for creating and sustaining assessment behaviour change in clinicians who used or attempted to use the C-BiLLT. Potential tailored intervention strategies aimed at improving implementation of novel assessment tools are discussed and may be helpful for others working to improve service delivery for children with complex needs.

Performance-based outcome measures of dexterity and hand function in person with hands and wrist injuries: A scoping review of measured constructs

BACKGROUND

Dexterity impairments are common and disabling. Currently, there is no consensus on an operational definition to measure dexterity.

PURPOSE

This review aims to provide an overview of constructs measured by performance-based outcome measures of dexterity and hand function (PBOMD) validated for use in persons with musculoskeletal hand and wrist conditions.

STUDY DESIGN

Scoping review, with qualitative content analysis.

METHODS

MEDLINE, Embase, CINAHL, PsycINFO were searched from inception until November 2019. Three reviewers identified studies investigating the psychometric properties of PBOMD in persons with hand and wrist conditions. Original articles and manuals of validated PBOMD were obtained. Reviewers independently extracted and performed a content analysis of constructs comparing the theoretical concepts of dexterity and function.

RESULTS

Twenty PBOMD were identified. PBOMD featured 1-57 tasks and 1-8 potential grasps patterns per tool. Description of the constructs measured indicated overlap between dexterity and hand function. In newer tools, there was a greater representation of daily activities to include domains like self-care and domestic life; and measurement of qualitative aspects of performance. Concurrently, there was less focus on mobility. The majority of identified tools (70%) used speed as the criterion evaluation of performance. None of the PBOMD evaluated dexterity associated with leisure activities or modern technologies like smartphones, nor measured the ability to adapt to changing demands when completing tasks.

CONCLUSIONS

Hand function and dexterity are imprecisely defined and operationalized in PBOMD. Dexterity is a complex construct that current PBOMD incompletely captures. PBOMD often quantified as the speed of movement, ignoring other important aspects like accommodating environmental changes during task performance. Clinicians should consider tasks included in PBOMD, the quantification method, and each PBOMD's limitations when choosing PBOMD.

Implementation strategies for knowledge products in primary healthcare: a systematic review of systematic reviews (Preprint)

Background

The underuse or overuse of knowledge products leads to waste in health care, and primary care is no exception.

Objective

This study aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured.

Methods

We performed a systematic review (SR) of SRs using the Cochrane systematic approach to include eligible SRs. The inclusion criteria were any primary care contexts, health care professionals and patients, any Effective Practice and Organization of Care implementation strategies of specified knowledge products, any comparators, and any implementation outcomes based on the Proctor framework. We searched the MEDLINE, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019 without any restrictions. We searched the references of the included SRs. Pairs of reviewers independently performed selection, data extraction, and methodological quality assessment by using A Measurement Tool to Assess Systematic Reviews 2. Data extraction was informed by the Effective Practice and Organization of Care taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results by using a narrative synthesis.

Results

Of the 11,101 records identified, 81 (0.73%) SRs were included. Of these 81, a total of 47 (58%) SRs involved health care professionals alone. Moreover, 15 SRs had a high or moderate methodological quality. Most of them addressed 1 type of knowledge product (56/81, 69%), common clinical practice guidelines (26/56, 46%) or management, and behavioral or pharmacological health interventions (24/56, 43%). Mixed strategies were used for implementation (67/81, 83%), predominantly education-based (meetings in 60/81, 74%; materials distribution in 59/81, 73%; and academic detailing in 45/81, 56%), reminder (53/81, 36%), and audit and feedback (40/81, 49%) strategies. Education meetings (P=.13) and academic detailing (P=.11) seemed to be used more when the population was composed of health care professionals alone. Improvements in the adoption of knowledge products were the most commonly measured outcome (72/81, 89%). The evidence level was reported in 12% (10/81) of SRs on 62 outcomes (including 48 improvements in adoption), of which 16 (26%) outcomes were of moderate or high level.

Conclusions

Clinical practice guidelines and management and behavioral or pharmacological health interventions are the most commonly implemented knowledge products and are implemented through the mixed use of educational, reminder, and audit and feedback strategies. There is a need for a strong methodology for the SR of randomized controlled trials to explore their effectiveness and the entire cascade of implementation outcomes.

Accelerating the Implementation of Evidence-Based Practice in Physical Medicine and Rehabilitation

Over the last three decades, a substantial number of studies were published with the purpose of improving the effectiveness and efficiency of rehabilitation clinical practice. Clinicians and researchers face considerable challenges in successfully implementing these research findings into routine clinical practice. Knowledge translation includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products, and strengthen the healthcare system. An aim of knowledge translation research is to identify strategies to accelerate implementation of evidence into practice. A recent citation analysis on a commonly used knowledge translation framework, the Knowledge-to-Action Framework, identified implementation activities performed in physical medicine and rehabilitation. While this citation analysis describes activities performed and outcomes assessed while conducting knowledge translation projects, successful knowledge translation also requires a robust social and physical infrastructure. In this commentary, we offer several observations that appear related to the increased likelihood of implementation success. Funders, higher education institutions, healthcare payers, and healthcare organizations contribute to successful implementation and must embrace their roles in implementation. Administrators, clinicians, and consumers of physical medicine and rehabilitation also have essential roles in knowledge translation.

Online learning versus workshops: a rank minimized trial comparing the effect of two knowledge translation strategies designed to alter knowledge, readiness to change, and self-efficacy with respect to rehabilitation outcome measures

PURPOSE

Traditional face-to-face learning is often replaced by virtual learning because it can be more feasible and cost-effective, and more recently due to the need for social distancing. The objective was to evaluate the effectiveness of two innovative knowledge translation (KT) interventions; in-person stakeholder-hosted, interactive, problem-based seminars (SHIPS) versus online problem-based tutorials (e-PBL) in changing knowledge, readiness to change, and self-efficacy with respect to the use of rehabilitation outcome measures.

METHODS

Physical and occupational therapists (n = 124) were recruited from four sites across Canada to participate in either an e-PBL or SHIPS. Evaluations of KT impact measured knowledge, self-efficacy to implement outcome measures in practice, and readiness to change.

RESULTS

There were 112 participants who completed the study. Following the intervention, the mean knowledge scores for both groups improved, but there was greater improvement in participants who completed SHIPS. For self-efficacy and readiness to change, there was no significant difference between groups six months following the interventions. E-PBL was as good as a SHIPS for improving and retaining self-efficacy and readiness to change.

CONCLUSIONS

Knowledge improved more with workshops than online delivery, while improvements in self-efficacy and readiness to change improved similarly regardless of delivery.Implications for RehabilitationThis study compared the relative efficacy of internet and workshop-based education, focusing specifically on the use of outcome measures in physical and occupational therapy practice.Improvements in the self-efficacy of rehabilitation professionals with respect to outcome measure use had lasting effects regardless of KT intervention type, as it was retained six months following the intervention.Results from this study show that online interventions may be as effective as face-to-face workshops for improving readiness to change and self-efficacy for using outcome measures in practice by rehabilitation professionals.This is valuable information given the recent global pandemic, the need for social distancing, and the potential for learning interventions to focus within the online environment in the future.

The meaning of rehabilitation: a qualitative study exploring perspectives of occupational therapists and physiotherapists working with older people in acute care

OBJECTIVE

To explore how occupational therapists and physiotherapists constructed and interpreted the meaning of rehabilitation in relation to older people in acute care.

DESIGN

A focussed ethnographic study was undertaken, primarily using observation, interviewing and review of clinical records within one acute medical ward in a general hospital in the UK. Five patient participants gave consent for their episode of care to be studied, with observations and interviews primarily involving the identified patients and five occupational therapy and physiotherapy professionals.

RESULTS

Four themes were identified: rehabilitation as a process to facilitate physical improvement; rehabilitation as physiotherapy-led; rehabilitation as a place…but not here; and rehabilitation as a process which prioritises safety over function. Such conceptualisations of rehabilitation were recognised as rooted in social and historical perceptions and challenged the ideals of rehabilitation professionals.

CONCLUSIONS

The meaning of rehabilitation in acute care is shaped by a range of cultural, contextual and systemic influences. Recognising these influences, and subsequent challenges to rehabilitation ideals, can encourage professionals to work towards meaningful change.Implications for RehabilitationA reductionist version of rehabilitation was evident within this context which placed value on physical improvement, achieving optimum safety and led by physiotherapy.This version of rehabilitation was unsatisfactory to occupational therapists and physiotherapists in this setting and different to their ideals.Where rehabilitation may be associated with another place, practitioners should reflect on whether this is influencing patients becoming a lower priority for interventions whilst waiting and address this, if required, within their own reasoning, prioritisation and delegation.Those who recognise similarities with their own practice context could individually, and within teams, revisit definitions of rehabilitation to notice, document and have conversations about the ideals of their professions versus the reality of practice.Occupational therapists and physiotherapists can be champions for organisational and cultural change to promote rehabilitation as a multi-disciplinary phase of care working towards optimising improvements in wellbeing, function and safety, irrespective of location.

Methodological Issues in Rehabilitation Research: A Scoping Review

OBJECTIVE

To identify, synthesize, and categorize the methodological issues faced by the rehabilitation field.

DATA SOURCES

A scoping review was conducted using studies identified in MEDLINE, the Cochrane Library, EMBASE, Web of Science, Scopus, Physiotherapy Evidence Database, and Google Scholar up to August 2018.

STUDY SELECTION

We included all type of publications describing methodological issues in rehabilitation research where rehabilitation is described as a multimodal process. The methodological issues have been categorized and classified.

DATA EXTRACTION

The synthesis included qualitative and quantitative analysis. To focus the attention on rehabilitation, we post hoc divided in "specific issues" (highly related to, even if not exclusive of, rehabilitation research) and "generic issues" (common in biomedical research).

DATA SYNTHESIS

Seventy-one publications were included: 68% were narrative reviews, 15% systematic reviews, 7% editorials, 4% meta-epidemiologic studies, and 5% others. Specific methodological issues include the following: problematic application of randomized controlled trials (32%), absent definition of core outcome sets (28%), poor interventions description (22%), weak methodological (conducting) and reporting quality (21%), scarce clinical practice applicability (14%), lack of blinding assessor (10%), inadequate randomization methods or inadequate allocation concealment (8%), and inadequate participants description and recruitment (8%). "Generic" issues included the following: data and statistical description (31%), authors' methodological training (7%), peer review process (6%, n=4), funding declaration (6%), ethical statement (3%), protocol registration (3%), and conflict of interest declaration (1%).

CONCLUSIONS

Methodological and reporting issues might influence the quality of the evidence produced in rehabilitation research. The next steps to move forward in the field of rehabilitation could be to evaluate the influence of all these issues on the validity of trial results through meta-epidemiologic studies and to develop specific checklists to provide guidance to authors to improve the reporting and conduct of trials in this field.

Knowledge translation intervention increased the use of outcome measures by physical therapists in inpatient rehabilitation

Background and Purpose: Outcome measures (OMs) have been emphasized by healthcare professions to optimize patient examination; however, a lack of regular use of OMs exists. The purpose of this study was to describe the outcome of a knowledge translation (KT) intervention to increase the use of OMs by physical therapists in an inpatient rehabilitation setting.Methods: A quasi-experimental pre-post study design was used. A multi-component KT intervention including education, organizational support, documentation, and environmental changes to increase the use of five OMs was implemented. Audit and feedback (A&F) was added to the KT intervention at month 6. Documented use of OMs was determined through manual chart audit (n = 864) and electronically (n = 2599). Regression analyses were used to identify factors associated with OMs use across time and diagnoses.Results: Following the addition of A&F to the KT intervention at month 6, there was a significant increase in the odds of OMs use across all time intervals (months 6-12, 12-18, 18-24)(Odds Ratio (OR) 5.9, 95% Confidence Interval (CI) 4.1-8.5; OR 8.5, 95% CI 6.0-12.1; OR 10.8, 95% CI 7.6-15). There was also a significant increase in the odds of documenting OMs on individuals with neurological diagnoses (OR 0.3, 95% CI 0.5-0.8).Conclusions: This KT intervention increased and sustained OMs use over 24-months. This intervention can be replicated to improve the evidence-based practices of physical therapists.

Knowledge Translation Research to Promote Behavior Changes in Rehabilitation: Use of Theoretical Frameworks and Tailored Interventions: A Scoping Review

OBJECTIVE

To describe knowledge translation (KT) research as a means of changing practice behaviors in rehabilitation. We specifically aimed to explore how theories, models, and frameworks (TMFs) are used to guide KT, guide methods to tailor KT interventions, and evaluate outcomes. We hypothesized these methods would have increased over the past 10 years.

DATA SOURCES

We identified articles through searches conducted using databases Cumulative Index to Nursing and Allied Health, MEDLINE, PubMed, Academic Search Premier, and previous reviews from January 2000 to April 2020. Search terms included physical therapy, occupational therapy, speech-language pathology, knowledge translation, and knowledge-to-action (KTA).

STUDY SELECTION

Two authors interpedently screened titles, abstracts, and full-text articles. Studies were included if behavior change of rehabilitation practitioners was measured. Systematic reviews, protocols, and capacity-building interventions were excluded.

DATA EXTRACTION

Three authors extracted information on study design, theoretical frameworks, intervention strategies, and outcome evaluation.

DATA SYNTHESIS

Fifty-six studies were included in the review. Sixteen (29%) reported the use of a theoretical framework to guide the KT process. Since 2013, the KTA framework was used 35% of the time. Twenty-two studies (39%) reported barrier assessments to tailor interventions, and 82% were published after 2013. However, barrier assessment in the local context was only conducted 64% of the time. Outcomes of tailored interventions were most frequently measured using chart audits (50%) and questionnaires (41%). Further, the link between KT theory, specific barriers, and selection of intervention strategies was not consistently described.

CONCLUSIONS

Over the past 7 years, there has been an increase in the use of KT TMFs and tailored interventions. Recommendations for future research include the use of TMFs to guide local barrier assessment, KT strategy selection, intervention development, and overall KT process and mapping barriers to selected intervention strategies.

Applying the Knowledge-to-Action Framework to Implement Gait and Balance Assessments in Inpatient Stroke Rehabilitation

OBJECTIVES

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 effect of the study intervention on clinician adherence to the recommendations and its effect on clinician perceptions and the organization.

DESIGN

Pre- and post-training intervention study.

SETTING

Subacute inpatient rehabilitation facility.

PARTICIPANTS

Physical therapists (N=6) and physical therapist assistants (N=2).

INTERVENTION

The intervention comprised a bundle of activities, including codeveloping and executing the plan with clinicians and leaders. The multicomponent 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 more than 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 because of using the bundle of knowledge translation activities, facilitation, and use of a framework to codevelop the plan. These changes in practice were sustainable, as determined by a 4-year follow-up.

Commentary on the Challenges and Benefits of Implementing Standardized Outcome Measures

The Institute of Medicine (now the National Academy of Medicine) has proposed a Learning Heath system (LHS) as a model to improve health care. A LHS focuses on capturing data from the clinical encounter and applying those data to improve practice. The process can be described as an iterative learning cycle composed of 3 areas: performance to data, data to knowledge, and knowledge to performance or often knowledge translation. Adoption of new knowledge in medicine is notoriously slow, and the relatively new field of knowledge translation is systematically examining the critical success factors. In this issue of the Archives, Moore reports a knowledge translation project in a key aspect of rehabilitation: implementing standardized outcome measures. We report on the challenges and benefits of that project from a practical perspective and identify the critical success ingredient, leadership for implementation, which was composed of 3 key behaviors: setting clear expectations, engaging stakeholders, and providing support. Furthermore, the additional benefits, challenges, and costs are addressed.

Core outcome sets through the healthcare ecosystem: the case of type 2 diabetes mellitus

BACKGROUND

It is increasingly accepted that insufficient attention has been given to the patient health outcomes that are important to measure in comparative effectiveness research that will inform decision-making. The relationship between outcomes chosen for comparative effectiveness research, outcomes used in decision-making in routine care, and outcome data recorded in electronic health records (EHR) is also poorly understood. The COMET Initiative (http://www.comet-initiative.org/. Accessed 3 Apr 2020) supports and encourages the development and use of 'core outcome sets' (COS), which represent the minimum set of patient health outcomes that should be measured and reported for a specific condition. There is growing interest in identifying how COS might fit into the different stages of the healthcare research and delivery ecosystem, and whether inclusion in the EHR might facilitate this.

METHODS

We sought to determine the degree of overlap between outcomes within COS for research and routine care, EMA, FDA and NICE guidelines, NICE quality statements/indicators, EHR and a point-of-care randomised clinical trial, using type 2 diabetes (T2D) as a case study.

RESULTS

There is substantial agreement about important patient outcomes for T2D for research and healthcare, with associated coverage within the UK general practice EHR.

CONCLUSIONS

This case study has demonstrated the potential for efficient research and value-based healthcare when the EHR can include COS for both research and care, where the COS comprises outcomes of importance to all relevant stakeholders. However, this concordance may not hold more generally, as the focus on patient-centred outcomes may well be greater in T2D than in other conditions. Work is ongoing to examine other clinical areas, in order to highlight any current inefficiencies when health outcomes in research and healthcare do not agree with core outcomes identified by patients, clinicians and other key stakeholders.

Behaviour Change Domains Likely to Influence Occupational Therapist Use of the Canadian Occupational Performance Measure

INTRODUCTION

Occupational therapists have shown low adoption rates for many evidence-based practices. One such practice is the limited uptake of standardized outcome measures such as the Canadian Occupational Performance Measure. Use of this measure has not consistently translated into practice despite decades of encouragement. Theory-based approaches to understanding healthcare provider behaviour change are needed if we are to realize the goal of attaining practice that is in keeping with evidence. This study utilized the Theoretical Domains Framework, a theory-based approach for understanding barriers to evidence-based practice, in order to increase our understanding of the limited uptake of the Canadian Occupational Performance Measure in occupational therapy practice.

METHODS

Theoretical Domains Framework methods were followed. First, primary data was collected from occupational therapists through semistructured interviews that focused on key behaviour change domains as they related to the use of the Canadian Occupational Performance Measure. Two independent researchers coded interview data into domains, derived belief statements from the data, and used belief strength, conflict, and frequency to determine the more and less influential domains for using the Canadian Occupational Performance Measure.

RESULTS

Interviews with 15 practicing occupational therapists across a range of practice areas yielded six key behaviour change domains for increasing the use of the Canadian Occupational Performance Measure. The more relevant domains were Social influences, Social professional role and identity, Beliefs about consequences, Beliefs about capabilities, Skills, and Behavioural regulation). The other eight domains were found to be less relevant.

CONCLUSION

We identified important domains and beliefs that influence the use of the Canadian Occupational Performance Measure by occupational therapists. Results inform our understanding of the use of this measure in practice and identify potential targets for behaviour change interventions.

Initial development of a measure of evidence-informed professional thinking

BACKGROUND AND AIMS

A number of theories have been proposed on clinical expertise and its development in occupational therapy and allied health professions. Clinical reasoning, outcome measurement and evidence-based practice are names for leading conceptualisations. The aim of this research was to develop an operational measure of habits of mind and practice that constitute these desirable professional activities amongst professional therapists.

METHODS

Items were developed on the basis of literature review and feedback from an expert panel. An online self-report survey was completed by 107 occupational therapists and other allied health clinicians. Rasch analysis was used to identify and calibrate items that fit the criteria for equal-interval measurement. Residuals from identified equal-interval dimensions were examined using principal components analysis to identify multidimensionality.

RESULTS

A two-dimension solution employing 32 items was identified. The first dimension comprised items on Critical Clinical Reasoning and had an item separation of 8.49 (0.99 reliability) and a person separation of 2.93 (0.90 reliability). The second dimension comprised items on Evidence-Informed Practice behaviours and had an item separation of 6.19 (0.97 reliability) and a person separation of 2.97 (0.90 reliability). These dimensions were positively correlated (r = .778, p < .001). We named the overall scale 'Evidence-Informed Professional Thinking', or EIPT. The EIPT measures correlated significantly with 12 of 13 relevant external criterion items.

CONCLUSION

Evidence-informed professional thinking can be measured in terms of two correlated probabilistically equal-interval dimensions: Critical Clinical Reasoning and Evidence-Informed Practice behaviours. The EIPT measure should be useful in research on development and application of clinical expertise, quality and outcomes of care and implementation of improved practices among practicing therapists in clinical treatment settings. Further research is recommended to understand the generalisability, strengths, limitations and correlates of EIPT.

The standing and walking assessment tool for individuals with spinal cord injury: A qualitative study of validity and clinical use

Context/Objective: The Spinal Cord Injury (SCI) Standing and Walking Assessment Tool (SWAT) combines stages of walking recovery with measures of balance and walking. It standardizes the timing and content of walking assessment in inpatient rehabilitation. The study aims were: (1) Evaluate the content validity of the SWAT stages of walking recovery, and (2) Understand physical therapists' (PTs) experiences using the SWAT to gauge acceptance, implementation and impact. Design: Qualitative, exploratory study. Setting: Nine Canadian rehabilitation hospitals. Participants: Thirty-four PTs who had used the SWAT ≥10 times. Interventions: Seven focus group meetings were completed. Semi-structured questions queried the content, order and spacing of SWAT stages, and current SWAT use (i.e. processes, challenges, facilitators, impact on practice). Meetings were audio-recorded and transcribed. Themes and categories were derived through a conventional content analysis. Outcome Measure: Not applicable. Results: PTs agreed with the ordering and content of the SWAT stages, but reported unequal spacing between stages. Three themes related to PTs' use of the SWAT were identified: (1) Variable process: SWAT implementation varied across sites, PTs and patients. (2) Implementation challenges: unfamiliarity of the SWAT, lack of time, not required by place of work, and patients who are outliers or have poor gait quality. (3) Potential to influence clinical decision-making: the SWAT did not influence clinical decisions, but PTs recognized the potential of the tool to do so. Conclusions: Content validity of the SWAT stages was supported and implementation challenges identified. Variability in SWAT implementation may reflect the heterogeneity and person-centeredness of SCI rehabilitation.

A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation: A CLINICAL PRACTICE GUIDELINE

Supplemental Digital Content is Available in the Text.

Background:

Use of outcome measures (OMs) in adult neurologic physical therapy is essential for monitoring changes in a patient's status over time, quantifying observations and patient-reported function, enhancing communication, and increasing the efficiency of patient care. OMs also provide a mechanism to compare patient and organizational outcomes, examine intervention effectiveness, and generate new knowledge. This clinical practice guideline (CPG) examined the literature related to OMs of balance, gait, transfers, and patient-stated goals to identify a core set of OMs for use across adults with neurologic conditions and practice settings.

Methods:

To determine the scope of this CPG, surveys were conducted to assess the needs and priorities of consumers and physical therapists. OMs were identified through recommendations of the Academy of Neurologic Physical Therapy's Evidence Database to Guide Effectiveness task forces. A systematic review of the literature on the OMs was conducted and additional OMs were identified; the literature search was repeated on these measures. Articles meeting the inclusion criteria were critically appraised by 2 reviewers using a modified version of the COnsensus-based Standards for the selection of health Measurement INstruments. (COSMIN) checklist. Methodological quality and the strength of statistical results were determined. To be recommended for the core set, the OMs needed to demonstrate excellent psychometric properties in high-quality studies across neurologic conditions.

Results/Discussion:

Based on survey results, the CPG focuses on OMs that have acceptable clinical utility and can be used to assess change over time in a patient's balance, gait, transfers, and patient-stated goals. Strong, level I evidence supports the use of the Berg Balance Scale to assess changes in static and dynamic sitting and standing balance and the Activities-specific Balance Confidence Scale to assess changes in balance confidence. Strong to moderate evidence supports the use of the Functional Gait Assessment to assess changes in dynamic balance while walking, the 10 meter Walk Test to assess changes in gait speed, and the 6-Minute Walk Test to assess changes in walking distance. Best practice evidence supports the use of the 5 Times Sit-to-Stand to assess sit to standing transfers. Evidence was insufficient to support use of a specific OM to assess patient-stated goals across adult neurologic conditions. Physical therapists should discuss the OM results with patients and collaboratively decide how the results should inform the plan of care.

Disclaimer:

The recommendations included in this CPG are intended as a guide for clinicians, patients, educators, and researchers to improve rehabilitation care and its impact on adults with neurologic conditions. The contents of this CPG were developed with support from the APTA and the Academy of Neurologic Physical Therapy (ANPT). The Guideline Development Group (GDG) used a rigorous review process and was able to freely express its findings and recommendations without influence from the APTA or the ANPT. The authors declare no competing interest.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A214.

Barriers to implementing evidence-based assessment procedures: Perspectives from the front lines in pediatric speech-language pathology

PURPOSE

This practice-based research study was a collaborative effort between researchers and speech-language pathologists (SLPs). The purpose of the study was to assess SLPs' perceptions of barriers for two new evidence-based assessment procedures to be implemented in practice. Procedures were for (1) program-level outcome monitoring and (2) individual vulnerability testing for children who are deaf or hard of hearing. These procedures were summarized for clinicians in an online learning module.

METHOD

After finishing the online learning module, SLPs completed electronic surveys to identify perceived barriers to implementation. Fifty-four SLPs completed an online survey specific to the program-level outcome monitoring procedures. Twenty-five also completed an online survey specific to individual vulnerability testing. Surveys were structured using the Ottawa Model of Research Use, which assesses barriers within three components: (1) the practice environment; (2) clinicians' knowledge, skills, and beliefs; and (3) the evidence-based innovation (development and content of the online learning module).

RESULTS

Most items specific to program-level outcome monitoring were rated positively. Some barriers were identified within the practice environment and evidence-based innovation, but clinicians' skills, knowledge, and beliefs were not barriers to implementation. For individual vulnerability testing, barriers were noted across all components of the Ottawa Model of Research Use.

CONCLUSIONS

This work demonstrates the value of including front-line clinicians in the development of evidence-based assessment procedures. Through practice-based research, we identified SLPs' perceived barriers to implementation, allowing for modifications to be made to the online learning module prior to wider-scale implementation. The barriers identified and methods used in our work may be useful to other researchers and programs involved in developing materials and methods for the implementation of evidence-based assessment procedures.

Steering towards collaborative assessment: a qualitative study of parents' experiences of evidence-based assessment practices for their child with cerebral palsy

PURPOSE

To understand parents' experiences of evidence-based assessment by health professionals for their child with cerebral palsy.

METHODS

A qualitative interpretive description study was undertaken. Primary carers of children with cerebral palsy (aged 3-18 years) from south-eastern Australia were invited to participate. Face-to-face interviews were held using a semi-structured topic guide and data analyzed inductively. Credibility was ensured through: journal reflections; co-author review; audit trail; and, participant member-checking.

RESULTS

Fourteen parents of children with cerebral palsy, representing Gross Motor Functional Classification System levels I-V, participated. Six themes emerged: (1) Protection; (2) Positively Framed; (3) Bridging the Gap; (4) Involvement; (5) Finding Worth; and (6) Trust. Central to parents' experience was protection of their child's identity and personal self. Assessment can be emotionally confronting, at any stage. Representing the child positively and highlighting possibilities was deemed essential. Parents' involvement ranged from being overlooked spectators to being instigators of assessment. Evidence-based assessment was worthwhile when relevant to parents' direction and family context. The researchers' interpretive description generated a schema and metaphor-the Steering Wheel for Collaborative Assessment.

CONCLUSIONS

A strengths-based approach to diagnosis and assessment is essential. The resulting interpretive description may assist health professionals align evidence-based assessment practices with family-centred care.Implications for rehabilitationParents of children who have cerebral palsy describe having to protect their child's identity and representation, and their own personal well-being, through evidence-based assessment and diagnostic processes.Involving parents in the process of evidence-based assessment and adopting a strengths-based approach is essential.The interpretive description developed-the Steering Wheel for Collaborative Assessment-may assist health professionals to implement evidence-based assessment tools in ways consistent with family-centred care principles.

An occupational therapy community development practice process

BACKGROUND.

Little research has focused on the application of the Canadian Practice Process Framework (CPPF) to occupational therapists' work in community development (CD).

PURPOSE.

This study sought to describe Canadian occupational therapists' CD practice processes.

METHOD.

Using interpretive description, Canadian occupational therapists engaged in CD practice participated in an initial interview and follow-up interview or focus group. Content analysis was used to analyze the data.

FINDINGS.

Eight occupational therapists participated in describing a process that focused on five key elements: (1) getting to know the community, (2) getting the ball rolling/planning together, (3) building (upon) occupational opportunities, (4) revisiting the approach, and (5) striving for sustainability. These elements occurred within a practice context and frames of reference related to CD practice.

IMPLICATIONS.

Participants outlined a process that was less discrete than the CPPF and highlighted the knowledge and skills needed along with the less tangible attitudes/approaches required to engage with communities.

Development of a participatory, tailored behaviour change intervention to increase active practice during inpatient stroke rehabilitation

Purpose: An evidence-practice gap exists between the amount of active practice recommended and the amount completed by stroke inpatients. The aim of this paper is to describe steps in the design of a participatory, theoretically tailored staff behaviour change intervention to help staff use strategies to increase active practice by stroke inpatients.Methods: A staff behaviour change intervention was developed in one rehabilitation unit in Queensland, Australia using a six-step process guided by the Behaviour Change Wheel framework. Mixed methods were used including direct observation (behavioural mapping), and focus groups to identify barriers and facilitators to implementation. Barriers and facilitators were mapped to the behaviour change techniques, and a behaviour change intervention developed in participation with rehabilitation staff.Results: Staff chose to implement ward-based practice books. Barriers included patient factors (including low motivation and severity of stroke), environmental segregation and limited skills for motivating patients. Staff belief in increasing active practice was a facilitator to implementation. The staff intervention included a training programme about motivation, environmental restructuring, audit, and feedback.Conclusions: This example of collaborative implementation research can be used and adapted by clinicians and researchers in other rehabilitation services.IMPLICATIONS FOR REHABILITATIONRehabilitation staff can be actively involved in designing behaviour change interventions.Behaviour change interventions should target local barriers to increase activity levels and practice completed by stroke inpatients.The process of co-designing behaviour change interventions has the potential to improve the uptake of a strategy such as ward-based practice books, by more precisely identifying local barriers and possible solutions.

Overview of reviews of standardised occupation-based instruments for use in occupational therapy practice

INTRODUCTION

Using standardised instruments is one approach to support evidence-based practice. Referring to systematic reviews is an option to identify suitable instruments. However, with an abundance of systematic reviews available, therapists are challenged to identify an appropriate instrument to use. Therefore, this overview of reviews aimed to summarise relevant systematic review findings about standardised occupation-based instruments relevant for occupational therapy practice.

METHODS

An overview of reviews was conducted. A systematic search was performed on four databases up to March 2018. Included systematic reviews were analysed for quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR).

RESULTS

A total of 2187 articles were identified after removing duplicates. Ultimately, 58 systematic reviews were identified that yielded 641 instruments. From those, 45 instruments were selected for appraisal as they met the inclusion criteria of being developed mainly by occupational therapists and were recommended in the summarised findings from the systematic reviews. The instruments were classified according to the following occupation domains: (i) multidimensional, (ii) activities of daily living, (iii) productivity, (iv) social, (v) sleep/rest, (vi) sexuality and (vii) spirituality. No systematic review was identified that specifically focussed on occupations related to school/education, leisure and play.

DISCUSSION

Certain occupation domains such as activities of daily living, social and sleep/rest received high attention amongst researchers. There is a need for systematic reviews of instruments to measure education/school, play and leisure. Limited numbers of instruments were developed by occupational therapists outside the occupation domain of activities of daily living, and in areas of practice other than children and older people. Nevertheless, this overview can give some guidance for occupational therapists in selecting a suitable occupational therapy instrument for practice.

General group exercise in low back pain management in a military population, a comparison with specific spine group exercise: a service evaluation

Objective

To investigate whether general group exercise (GGE) offers the same outcomes compared with a specific spinal group exercise (SSGE) for chronic low back pain (CLBP) in a military population.

Design

Retrospective service evaluation using routine service activity data.

Setting

A UK military rehabilitation centre.

Participants

A total of 106 patients with CLBP.

Interventions

Three-week intensive (5 days per week, 15-day intervention) rehabilitation course for patients with CLBP. Six SSGE groups (n=64); CLBP only. Six GGE groups (n=42); CLBP patients grouped with chronic lower limb (LL) injuries.

Outcome measures

Oswestry Disability Index (ODI), Numerical Pain-Rating Scores and the Modified Multi-Stage Fitness Test (Mod-MSFT). Long-term effects were measured by Medical Employment Standard (MES) status and physiotherapy follow-up at 3 and 12 months.

Results

A between-group analysis showed no significant difference in GGE compared with SSGE. Mean changes (SD) in pain were −2.71±2.35 and −1.20±1.99 (p=0.018), ODI were −3.6±5.7 and −4±8.5 respectively (p=0.649) and Mod-MSFT 28.4±30.8 and 29.7±31.7 respectively (p=0.792). At 3 months, a greater proportion of the GGE were having ongoing physiotherapy; GGE=50%, SSGE=30.2%, (p=0.016) although some differences were evident across MES with 32.5 % of GGE compared with 20.6 % of SSGE being medically fit with no restrictions. At 12 months, groups were largely comparable for follow-up physiotherapy and MES; 22.5% of GGE and 20.6% of SSGE continued to have physiotherapy input; 47.5% of GGE and 50.8% of SSGE were medically fit with no restrictions.

Conclusion

Patients with CLBP who completed a 3-week rehabilitation programme had comparable outcomes when grouped with patients with LL, although only improvements in pain in the GGE group achieved a meaningful change. Further evaluation of potential costs and savings to service costs is now required.

A theory-based multi-component intervention to increase reactive balance measurement by physiotherapists in three rehabilitation hospitals: an uncontrolled single group study

BACKGROUND

Most implementation interventions in rehabilitation, including physiotherapy, have used passive, non-theoretical approaches without demonstrated effectiveness. The goal of this study was to improve an important domain of physiotherapy practice - reactive balance measurement - with a targeted theory-based multi-component intervention developed using the Theoretical Domains Framework. The primary objective was to determine documented reactive balance measure use in a 12-month baseline, during, and for three months post- intervention.

METHODS

An uncontrolled before-and-after study was completed with physiotherapists at three urban adult rehabilitation hospitals in Ontario, Canada. The 12-month intervention included group meetings, local champions, and health record modifications for a validated reactive balance measure. The primary outcome was the proportion of records with a documented reactive balance measure when balance was assessed pre-, during- and post-intervention. Secondary outcomes were changes in use, knowledge, and confidence post-intervention, differences across sites, and intervention satisfaction.

RESULTS

Reactive balance was not measured in any of 211 eligible pre-intervention records. Thirty-three physiotherapists enrolled and 28 completed the study. Reactive balance was measured in 31% of 300 eligible records during-intervention, and in 19% of 90 eligible records post-intervention (p < 0.04). Knowledge and confidence significantly increased post-intervention (all p < 0.05). There were significant site differences in use during- and post-intervention (all p < 0.05). Most participants reported satisfaction with intervention content (71%) and delivery (68%).

CONCLUSIONS

Reactive balance measurement was greater among participants during-intervention relative to the baseline, and use was partially sustained post-intervention. Continued study of intervention influences on clinical reasoning and exploration of site differences is warranted.

Reliability and validity of the Assessment of Client's Enablement (ACE)

Introduction

Goal-setting in client-centred occupational therapy is often problematic. The Assessment of Client's Enablement was developed to measure the gap between an occupational therapist's and client's ratings of occupational performance. This study examines the reliability and convergent validity of the assessment.

Method

The assessment was used by 22 occupational therapists with 44 clients. Convergent validity was examined between the assessment (client, occupational therapist and gap scores), Canadian Occupational Performance Measure performance and Functional Independence Measure scores. Test–retest reliability was assessed by intraclass correlation coefficient. Forty-four clients participated in the test–retest reliability study.

Findings

Good-to-moderate correlation was found in the assessment scores (intraclass correlation coefficients of 0.86, 0.95 and 0.78 for client, occupational therapist and gap scores, respectively). The validation study was completed by 34 clients. The correlation between Canadian Occupational Performance Measure and Assessment of Client's Enablement scores was significant (client score, Spearman’s Rank Order Correlation (rs) = 0.47; occupational therapist score, rs = 0.45). The correlation between Functional Independence Measure and the assessment's occupational therapist scores was significant (rs = 0.43).

Conclusion

The study confirms the reliability and convergent validity of the Assessment of Client's Enablement. The assessment requires less time to administer than similar instruments and requires no formal training, making it feasible in rehabilitation settings.

Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge

BACKGROUND

The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of critical illness?

METHODS

A Delphi consensus study was conducted. Panelists were included based on relevant fields of expertise, years of clinical experience, and publication record. A literature review determined five themes, forming the basis for Delphi round one, which was aimed at generating ideas. Statements were drafted and ranked on a 5-point Likert scale in two additional rounds with the objective to reach consensus. Results were expressed as median and semi-interquartile range, with the consensus threshold set at ≤0.5.

RESULTS

Ten internationally established researchers and clinicians participated in this Delphi panel, with a response rate of 80 %, 100 %, and 100 % across three rounds. Consensus was reached on 88.5 % of the statements, resulting in a framework for PT after hospital discharge. Essential handover information should include information on 15 parameters. A core set of outcomes should test exercise capacity, skeletal muscle strength, function in activities of daily living, mobility, quality of life, and pain. PT interventions should include functional exercises, circuit and endurance training, strengthening exercises for limb and respiratory muscles, education on recovery, and a nutritional component. Screening tools to identify impairments in other health domains and referral to specialists are proposed.

CONCLUSIONS

A consensus-based framework for optimal PT after hospital discharge is proposed. Future research should focus on feasibility testing of this framework, developing risk stratification tools and validating core outcome measures for ICU survivors.