A Network of Sites and Upskilled Therapists to Deliver Best-Practice Stroke Rehabilitation of the Arm: Protocol for a Knowledge Translation Study.

Implementation of evidence-informed rehabilitation of the upper limb is variable, and outcomes for stroke survivors are often suboptimal. We established a national partnership of clinicians, survivors of stroke, researchers, healthcare organizations, and policy makers to facilitate change. The objectives of this study are to increase access to best-evidence rehabilitation of the upper limb and improve outcomes for stroke survivors. This prospective pragmatic, knowledge translation study involves four new specialist therapy centers to deliver best-evidence upper-limb sensory rehabilitation (known as SENSe therapy) for survivors of stroke in the community. A knowledge-transfer intervention will be used to upskill therapists and guide implementation. Specialist centers will deliver SENSe therapy, an effective and recommended therapy, to stroke survivors in the community. Outcomes include number of successful deliveries of SENSe therapy by credentialled therapists; improved somatosensory function for stroke survivors; improved performance in self-selected activities, arm use, and quality of life; treatment fidelity and confidence to deliver therapy; and for future implementation, expert therapist effect and cost-effectiveness. In summary, we will determine the effect of a national partnership to increase access to evidence-based upper-limb sensory rehabilitation following stroke. If effective, this knowledge-transfer intervention could be used to optimize the delivery of other complex, evidence-based rehabilitation interventions.

Development of an audit checklist to evaluate treatment fidelity of a complex rehabilitation intervention.

PURPOSE: The process of examining treatment fidelity is critical to the successful implementation of rehabilitation interventions. Videotaping is considered the 'gold standard' assessment; however, may be considered resource-intensive and intrusive for intervention providers and patients. An audit checklist is an alternative approach recommended in the literature. The purpose of this study was to develop a documentation audit checklist for assessing treatment fidelity during delivery of SENSe therapy, a complex rehabilitation intervention targeting upper limb somatosensory impairment post-stroke. METHODS: Checklist development comprised: content determination and design; checklist testing via audit of 38 therapy records from an existing data set; and exploration of rater agreement between two assessors, using a subset of 10 therapy records. RESULTS: The developed audit checklist comprised 29 components core to the delivery of SENSe therapy. Six SENSe therapy records were delivered with high fidelity (>80% adherence to core components), and 32 with moderate fidelity (51-79%). Rater agreement was 80% across the subset of 10 records. CONCLUSION: Findings highlight the importance of using a theoretically-guided approach to checklist development, with the use of rater agreement to identify areas for refinement. A documentation audit checklist was developed that can be used to evaluate treatment fidelity of complex rehabilitation interventions.IMPLICATIONS FOR REHABILITATIONDevelopment of an audit checklist that evaluates clinician documentation of therapy delivery, is feasible as one strategy to measure and enhance the treatment fidelity of complex rehabilitation interventions.The process of audit checklist development should be structured and based on conceptual frameworks, to ensure it accurately measures quality of delivery and adherence to core intervention components.Audit checklists can be used to support clinicians delivering complex rehabilitation interventions.

The Performance Quality Rating Scale for Somatosensation After Stroke: A Pilot Study.

To our knowledge, no measure of observed performance in self-selected activities has been specifically tested for use with stroke survivors with somatosensory deficits. The objective of this study is to modify the Performance Quality Rating Scale (PQRS) for use with stroke survivors with somatosensory deficits and report the interrater reliability. Videos of stroke survivors (N = 22) with somatosensory deficits performing self-selected activities on two separate occasions (76 video clips; 38 activities) were viewed by two clinicians who rated performance using the modified PQRS. Reported properties of the modified PQRS included the interclass correlation coefficient (ICC2,1), Spearman's rho and standard error of measurement (SEM). Interrater reliability was good (ICC2,1 = 0.81). Raters' scores correlated highly (Spearman's rho = 0.81), and the SEM (1.07) was acceptable. The modified PQRS demonstrated good interrater reliability. Further modifications such as developing common operational definitions that are applicable across a wide range of activities may improve the clinical usability of the scale.