The Children's Trust, Neurorehabilitation, Tadworth Court, Surrey KT20 5RU, UK.
Occupational Therapy Division, Department of Allied Health, Social Care and Advanced Practice, School of Health and Social Care, London South Bank University, London SE1 6LN, UK.
Int J Environ Res Public Health. 2020 Nov 24;17(23):8736. doi: 10.3390/ijerph17238736.
Children with acquired brain injury experience participation restrictions. Pathways and Resources for Participation and Engagement (PREP) is an innovative, participation focused intervention. Studies have examined PREP in Canadian research contexts, however little is known about implementation in real-life clinical settings. This study aimed to understand experiences of clinicians implementing PREP in a UK clinical context, with a focus on implementation processes and key factors for successful implementation.
A qualitative single-site 8-week knowledge translation intervention study, guided by an action research framework, explored clinicians' experiences of implementation. Six occupational therapists (OTs) working in a neurorehabilitation setting participated. The therapists provided two intervention sessions per week, over four weeks for one child on their caseload. Planning, implementation and evaluation were explored through two focus groups. Thematic analysis was used to analyse data.
Two themes, "key ingredients before you start" and "PREP guides the journey", were identified before introducing PREP to practice. Four additional themes were related to PREP implementation: "shifting to a participation perspective", "participation moves beyond the OT", "environmental challengers and remedies" and "whole family readiness". A participation ripple effect was observed by building capacity across the multi-disciplinary team and families. The involvement of peers, social opportunities and acknowledging family readiness were key factors for successful implementation.
The findings illustrate practical guidance to facilitate the uptake of participation-based evidence in clinical practice. Further research is required to understand aspects of knowledge translation when implementing participation interventions in other UK clinical settings.
患有后天性脑损伤的儿童会经历参与受限的问题。参与和投入路径及资源（PREP）是一种创新的、以参与为重点的干预措施。已有研究在加拿大研究背景下对 PREP 进行了检验，但在现实临床环境中实施 PREP 的情况知之甚少。本研究旨在了解临床医生在英国临床环境中实施 PREP 的经验，重点是实施过程和成功实施的关键因素。
一项定性单站点 8 周知识转化干预研究，以行动研究框架为指导，探讨了临床医生实施 PREP 的经验。六名在神经康复环境中工作的职业治疗师（OT）参与了研究。治疗师每周为其病例中的一名儿童提供两次干预，共进行四周。通过两次焦点小组探讨了计划、实施和评估。使用主题分析来分析数据。
在将 PREP 引入实践之前，确定了两个主题，“开始前的关键要素”和“PREP 指导旅程”。另外四个与 PREP 实施相关的主题：“转向参与视角”、“参与超越 OT”、“环境挑战和补救措施”和“整个家庭准备就绪”。通过跨多学科团队和家庭建立能力，观察到了参与的连锁反应。同伴的参与、社交机会和承认家庭准备就绪是成功实施的关键因素。
研究结果提供了在临床实践中促进采用基于参与的证据的实用指导。需要进一步研究，以了解在其他英国临床环境中实施参与干预措施时知识转化的各个方面。
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