Connell Louise A, McMahon Naoimh E, Redfern Judith, Watkins Caroline L, Eng Janice J
Clinical Practice Research Unit, School of Health, University of Central Lancashire, Preston, PR1 2HE, England.
Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, V6T 1Z3, Vancouver, British Columbia, Canada.
Implement Sci. 2015 Mar 12;10:34. doi: 10.1186/s13012-015-0223-3.
Two thirds of survivors will achieve independent ambulation after a stroke, but less than half will recover upper limb function. There is strong evidence to support intensive repetitive task-oriented training for recovery after stroke. The number of repetitions needed is suggested to be in the order of hundreds, but this is not currently being achieved in clinical practice. In an effort to bridge this evidence-practice gap, we have developed a behaviour change intervention that aims to increase provision of upper limb repetitive task-oriented training in stroke rehabilitation. This paper aims to describe the systematic processes that took place in collaboratively developing the behaviour change intervention.
The methods used in this study were not defined a priori but were guided by the Behaviour Change Wheel. The process was collaborative and iterative with four stages of development emerging (i) establishing an intervention development group; (ii) structured discussions to understand the problem, prioritise target behaviours and analyse target behaviours; (iii) collaborative design of theoretically underpinned intervention components and (iv) piloting and refining of intervention components.
The intervention development group consisted of the research team and stroke therapy team at a local stroke rehabilitation unit. The group prioritised four target behaviours at the therapist level: (i) identifying suitable patients for exercises, (ii) provision of exercises, (iii) communicating exercises to family/visitors and (iv) monitoring and reviewing exercises. It also provides a method for self-monitoring performance in order to measure fidelity. The developed intervention, PRACTISE (Promoting Recovery of the Arm: Clinical Tools for Intensive Stroke Exercise), consists of team meetings and the PRACTISE Toolkit (screening tool and upper limb exercise plan, PRACTISE exercise pack and an audit tool).
This paper provides an example of how the Behaviour Change Wheel may be applied in the collaborative development of a behaviour change intervention for health professionals. The process involved was resource-intensive, and the iterative process was difficult to capture. The use of a published behaviour change framework and taxonomy will assist replication in future research and clinical use. The feasibility and acceptability of PRACTISE is currently being explored in two other stroke rehabilitation units.
三分之二的中风幸存者能够在中风后实现独立行走，但恢复上肢功能的不到一半。有强有力的证据支持中风后康复采用强化的以任务为导向的重复训练。所需的重复次数建议达到数百次，但目前在临床实践中尚未实现。为了弥合这一证据与实践之间的差距，我们开发了一种行为改变干预措施，旨在增加中风康复中上肢以任务为导向的重复训练。本文旨在描述在协同开发行为改变干预措施过程中所发生的系统流程。
本研究中使用的方法并非预先确定，而是以行为改变轮为指导。该过程是协作性和迭代性的，出现了四个发展阶段：（i）组建干预开发小组；（ii）进行结构化讨论以了解问题、确定目标行为的优先级并分析目标行为；（iii）对基于理论的干预组件进行协同设计；（iv）对干预组件进行试点和完善。
干预开发小组由当地中风康复单元的研究团队和中风治疗团队组成。该小组在治疗师层面确定了四个目标行为的优先级：（i）识别适合进行锻炼的患者；（ii）提供锻炼；（iii）向家属/访客传达锻炼内容；（iv）监测和评估锻炼情况。它还提供了一种自我监测表现的方法，以便衡量依从性。所开发的干预措施PRACTISE（促进手臂恢复：中风强化锻炼临床工具）包括团队会议和PRACTISE工具包（筛查工具和上肢锻炼计划、PRACTISE锻炼包以及审核工具）。
本文提供了一个示例，说明行为改变轮如何应用于为卫生专业人员协同开发行为改变干预措施。所涉及的过程资源密集，且迭代过程难以记录。使用已发表的行为改变框架和分类法将有助于未来研究和临床应用中的复制。目前正在另外两个中风康复单元探索PRACTISE的可行性和可接受性。
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