What is the feasibility and observed effect of two implementation packages for stroke rehabilitation therapists implementing upper limb guidelines? A cluster controlled feasibility study.
BACKGROUND
Hand and arm activity after stroke improves with evidence-based rehabilitation. Therapists face known barriers when providing evidence-based rehabilitation and require support to implement guidelines. The aim of this study was to investigate the feasibility of two implementation packages on guideline adherence by occupational therapists and physiotherapists, and explore effect on patient upper limb outcomes.


METHOD
This was a non-randomised clustered feasibility study of occupational and physiotherapy rehabilitation services (n=3 inpatient and n=3 outpatient services). Services were allocated to one of three groups: (group A) facilitator-mediated implementation package, (group B) self-directed implementation package or (group C) usual care (control); we recruited n=1 inpatient and n=1 outpatient service per group. Outcomes of feasibility, adherence to guidelines (medical file audits) and patient upper limb impairment (Fugl-Meyer Upper Extremity Assessment), activity (Box and Block Test) and practice (minutes/week) were collected at baseline and after 3 months of intervention.


RESULTS
29 therapists (8 in group A, 13 in groups B and 8 in group C) and 55 patients participated. Both the facilitator-mediated and the self-directed implementation packages were feasible to deliver in the rehabilitation setting. Therapists in group A improved with respect to guideline adherence (medical file audits; median within-group proportion difference of 0.29 (95% CI 0.22 to 0.36, p<0.0001) preintervention to postintervention). No significant within-group differences from baseline to postintervention were found in group B or group C, and no between-group differences were found for upper limb outcomes.


CONCLUSION
A facilitator-mediated package was acceptable to therapists working in stroke rehabilitation, and feasibility data suggest increased guideline uptake following implementation. An adequately powered study is planned to understand how to support therapists to provide evidence-based upper limb rehabilitation after stroke.


TRIAL REGISTRATION NUMBER
Australian New Zealand Clinical Trials Registry (ACTRN12619000596101).
['Jolliffe|Laura|L|0000-0002-1369-9442', 'Hoffmann|Tammy|T|0000-0001-5210-8548', 'Churilov|Leonid|L|0000-0002-9807-6606', 'Lannin|Natasha A|NA|0000-0002-2066-8345']
D000328:Adult D001291:Attitude of Health Personnel D001315:Australia D016000:Cluster Analysis D005240:Feasibility Studies D005260:Female D019983:Guideline Adherence D006801:Humans D008297:Male D008875:Middle Aged D020521:Stroke D000071939:Stroke Rehabilitation D034941:Upper Extremity
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