Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada.
Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, room 3-131 (3-East) 3rd Floor University Wing, Toronto, ON, M5G 2A2, Canada.
Implement Sci. 2017 Aug 1;12(1):100. doi: 10.1186/s13012-017-0631-7.
The Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT) showed that a facilitated knowledge translation (KT) approach to implementing a stroke rehabilitation guideline was more likely than passive strategies to improve functional walking capacity, but not gross manual dexterity, among patients in rehabilitation hospitals. This paper presents the results of a planned process evaluation designed to assess whether the type and number of recommended treatments implemented by stroke teams in each group would help to explain the results related to patient outcomes.
As part of a cluster randomized trial, 20 rehabilitation units were stratified by language and allocated to a facilitated or passive KT intervention group. Sites in the facilitated group received the guideline with treatment protocols and funding for a part-time nurse and therapist facilitator who attended a 2-day training workshop and promoted guideline implementation for 16 months. Sites in the passive group received the guideline excluding treatment protocols. As part of a process evaluation, nurses, and occupational and physical therapists, blinded to study hypotheses, were asked to record their implementation of 18 recommended treatments targeting motor function, postural control and mobility using individualized patient checklists after treatment sessions for 2 weeks pre- and post-intervention. The percentage of patients receiving each treatment pre- and post-intervention and between groups was compared after adjusting for clustering and covariates in a random-effects logistic regression analysis.
Data on treatment implementation from nine and eight sites in the facilitated and passive KT group, respectively, were available for analysis. The facilitated KT intervention was associated with improved implementation of sit-to-stand (p = 0.028) and walking (p = 0.043) training while the passive KT intervention was associated with improved implementation of standing balance training (p = 0.037), after adjusting for clustering at patient and provider levels and covariates.
Despite multiple strategies and resources, the facilitated KT intervention was unsuccessful in improving integration of 18 treatments concurrently. The facilitated approach may not have adequately addressed barriers to integrating numerous treatments simultaneously and complex treatments that were unfamiliar to providers.
Unique identifier- NCT00359593.
加拿大卒中康复知识转化优化试验（SCORE-IT）表明，与被动策略相比，促进知识转化（KT）方法更有可能提高康复医院患者的功能性行走能力，而不是总体手动灵巧性，以实施卒中康复指南。本文介绍了一项计划中的过程评估结果，旨在评估每组卒中团队实施的推荐治疗类型和数量是否有助于解释与患者结局相关的结果。
作为一项集群随机试验的一部分，将 20 个康复单位按语言分层，并分配到促进或被动 KT 干预组。促进组的站点收到了指南和治疗方案，并为兼职护士和治疗师促进者提供资金，该促进者参加了为期两天的培训研讨会，并在 16 个月内促进了指南的实施。被动组的站点收到了不包括治疗方案的指南。作为过程评估的一部分，在不知道研究假设的情况下，护士、职业治疗师和物理治疗师被要求在干预前后两周的治疗期间，使用针对运动功能、姿势控制和活动能力的个体化患者检查表，记录他们对 18 种推荐治疗方法的实施情况。在调整了患者和提供者层面的聚类和协变量后，比较了干预前后以及组间每个治疗方法的患者比例。
分别对促进和被动 KT 组的九个和八个站点的治疗实施数据进行了分析。在调整了患者和提供者层面的聚类和协变量后，促进 KT 干预与坐立训练（p=0.028）和行走训练（p=0.043）的改善实施相关，而被动 KT 干预与站立平衡训练的改善实施相关（p=0.037）。
尽管采取了多种策略和资源，促进 KT 干预在同时整合 18 种治疗方法方面仍不成功。促进方法可能没有充分解决同时整合多种治疗方法和提供者不熟悉的复杂治疗方法的障碍。
唯一标识符-NCT00359593。
