Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden. E-mail:
J Rehabil Med. 2021 Jan 29;53(1):jrm00148. doi: 10.2340/16501977-2790.
There is an evidence-practice gap in assessment of the upper extremities during acute and subacute stroke rehabilitation. The aim of this study was to target this gap by describing and evaluating the implementation of, and adherence to, an evidence--based clinical practice guideline for occupational therapists and physiotherapists.
The upper extremity assessment implementation process at Sahlgrenska University Hospital comprised 5 stages: mapping clinical practice, identifying evidence-based outcome measures, development of a guideline, implementation, and evaluation. A systematic theoretical framework was used to guide and facilitate the implementation process. A survey, answered by 44 clinicians (23 physiotherapists and 21 occupational therapists), was used for evaluation.
The guideline includes 6 primary standard-ized assessments (Shoulder Abduction, Finger Extension (SAFE), 2 items of the Actions Research Arm Test (ARAT-2), Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Box and Block Test (BBT), 9-Hole Peg Test (9HPT), and grip strength (Jamar hand dynamometer)) per-formed at specified time-points post-stroke. More than 80% (35 to 42) clinicians reported reported being content with the guideline and the implementation process. Approximately 60-90% of the clinicians reported good adherence to specific assessments, and approximately 50% report-ed good adherence to the agreed time-points. Comprehensive scales were more difficult to implement compared with the shorter screening scales. High levels of work rotation among staff, and the need to prioritize other assessments during the first week after stroke, hindered to implementation.
The robustness of evidence, adequate support and receptive context facilitated the implementation process. The guideline enables a more structured, knowledge-based and consistent assessment, and thereby supports clinical decision-making and patient involvement.
在急性和亚急性脑卒中康复期间，上肢评估存在证据与实践之间的差距。本研究旨在通过描述和评估作业治疗师和物理治疗师实施和遵循基于证据的临床实践指南的情况来弥补这一差距。
在萨赫勒格伦斯卡大学医院，上肢评估实施过程包括 5 个阶段：映射临床实践、确定基于证据的结果测量、制定指南、实施和评估。使用系统的理论框架来指导和促进实施过程。通过一项调查（由 44 名临床医生（23 名物理治疗师和 21 名作业治疗师）回答）来评估实施情况。
该指南包括 6 项主要标准化评估（肩外展、手指伸展（SAFE）、动作研究上肢测试（ARAT-2）的 2 项、上肢 Fugl-Meyer 评估（FMA-UE）、箱式和块式测试（BBT）、9 孔钉测试（9HPT）和握力（Jamar 手持测力计）），在脑卒中后特定时间点进行。超过 80%（35 到 42）的临床医生报告对指南和实施过程感到满意。大约 60-90%的临床医生报告对特定评估的依从性良好，大约 50%报告对商定的时间点的依从性良好。综合量表比较短的筛查量表更难实施。工作人员的工作轮换水平高，以及在脑卒中后第一周需要优先考虑其他评估，这都阻碍了实施。
证据的稳健性、充分的支持和接受的环境促进了实施过程。该指南可实现更结构化、基于知识和一致的评估，从而支持临床决策和患者参与。
