College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia.
Occupational Therapy Department, Central Adelaide Health Service, Adelaide, South Australia, Australia.
Health Expect. 2024 Feb;27(1):e13904. doi: 10.1111/hex.13904. Epub 2023 Nov 21.
People with lived experience are rarely involved in implementation science research. This study was designed to assess the feasibility of codesigning and delivering implementation strategies with people with lived experience of stroke and health professionals to improve evidence-based stroke rehabilitation.
We used Experience-Based CoDesign to design and deliver strategies to implement Stroke Clinical Guideline recommendations at one Australian inpatient stroke rehabilitation unit. Workgroups were formed with health professionals and people with 6-12 months experience of living with stroke (survivors and carers). Feasibility of the codesign approach (focusing on acceptability, implementation fidelity, signal of promise) was evaluated using mixed methods, using data from interviews, observations and inpatient self-reported outcomes.
Of 18 people with stroke invited, eight (44%) agreed to join the lived experience workgroup. All disciplines with ≥1 full-time staff members on the stroke unit were represented on the health professional workgroup. Median workgroup attendance over 6 months was n = 8 health professionals, n = 4 survivors of stroke and n = 1 carers. Workgroup members agreed to focus on two Guideline recommendations: information provision and amount of therapy. Workgroup members indicated that the codesign approach was enjoyable and facilitated effective partnerships between health professionals and lived experience workgroup members. Both cohorts reported contributing valuable input to all stages of the project, with responsibility shifting between groups at different project stages. The codesigned strategies signalled promise for improving aspects of information provision and creating additional opportunities for therapy. We could not compare patient-reported outcomes before and after the implementation period due to high variability between the preimplementation and postimplementation patient cohorts.
It is feasible to codesign implementation strategies in inpatient rehabilitation with people with lived experience of stroke and health professionals. More research is required to determine the effect of the codesigned strategies on patient and service outcomes.
People with lived experience of stroke codesigned and evaluated implementation strategies. Author F. C. has lived experience of stroke and being an inpatient at the inpatient rehabilitation service, and has provided input into analysis of the findings and preparation of this manuscript.
很少有具有实践经验的人参与实施科学研究。本研究旨在评估与经历过中风的人和健康专业人员共同设计和实施实施策略的可行性，以改善基于证据的中风康复。
我们使用基于经验的共同设计来设计和实施在澳大利亚一家住院中风康复病房实施中风临床指南建议的策略。成立了由健康专业人员和经历过中风 6-12 个月的人组成的工作组（幸存者和照顾者）。使用混合方法评估共同设计方法的可行性（重点是可接受性、实施保真度、有希望的信号），使用访谈、观察和住院患者自我报告结果的数据。
在邀请的 18 名中风患者中，有 8 名（44%）同意加入实践经验工作组。中风病房所有全职工作人员都参加了健康专业人员工作组。在 6 个月内，工作组的平均出席人数为 n=8 名健康专业人员、n=4 名中风幸存者和 n=1 名照顾者。工作组的成员同意关注两项指南建议：信息提供和治疗量。工作组的成员表示，共同设计方法令人愉快，并促进了健康专业人员和实践经验工作组成员之间的有效合作。两个群体都报告说，他们为项目的所有阶段提供了有价值的投入，在不同的项目阶段，责任在群体之间转移。共同设计的策略为改善信息提供方面和创造更多治疗机会发出了有希望的信号。由于实施前和实施后患者队列之间的变异性很大，我们无法比较实施前后的患者报告结果。
与经历过中风的人和健康专业人员一起在住院康复中共同设计实施策略是可行的。需要更多的研究来确定共同设计的策略对患者和服务结果的影响。
经历过中风的人共同设计和评估了实施策略。作者 F.C. 有中风和在住院康复服务住院的实践经验，并为分析研究结果和准备本手稿提供了意见。
