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.

The use of mentoring for knowledge translation by allied health: a scoping review.

OBJECTIVE: To describe how allied health professionals have used mentoring as a knowledge translation strategy to inform practice. INTRODUCTION: Mentoring has been reported to be used by nursing and medicine as a knowledge translation strategy. It is not known if allied health professionals have also used mentoring to improve their use of research in practice, or what the key mentoring characteristics are that guide its application in allied health settings. Improved understanding of the barriers and facilitators to mentoring in allied health settings may be used to guide the design of future mentoring programs to assist knowledge translation. INCLUSION CRITERIA: Eligible studies must have included allied health professionals, and used the concept of mentoring to support knowledge translation in the context of healthcare. Primary empirical and synthesized studies were eligible. METHODS: An a-priori protocol was followed to complete a search of six databases (MEDLINE [OVID], EMBASE [OVID], CINAHL [EBSCO], PsycInfo [OVID], PDQ-Evidence ( www.pdq-evidence.org ), and Cochrane on the 9 March 2021. Screening for eligibility was conducted by two authors at the title and abstract stage and the full text stage. Selection criteria and the data extraction tool were established prior to the search. Findings are presented in narrative and tabular formats. RESULTS: A total of 2053 studies met the inclusion criteria for screening and nine were determined to be eligible for inclusion. Mentoring has been used by allied health professionals to improve the translation of interventional research evidence by clinicians, and to establish clinician skills and knowledge relating to knowledge translation processes. Mentoring was predominantly used as part of a multifaceted knowledge translation strategy alongside educational strategies. Mentoring characteristics such as structure, context, goals, resourcing and dosage varied depending on the context of translation. The specific barriers reported to using mentoring were varied, whereas the facilitators to mentoring were primarily related to the mentor's approach and expertise. The impact of mentoring was primarily measured through the mentee's experience of mentoring. CONCLUSIONS: Allied health professionals have used mentoring as a knowledge translation strategy to enhance the use of research evidence in their practice and to learn the process of knowledge translation. Mentoring is mostly used in conjunction with other strategies in practice, such as education. The limited number of identified barriers and facilitators to using mentoring as a knowledge translation strategy supports the need for future research to deepen our understanding about the mentoring process.

Factors influencing allied health professionals' implementation of upper limb sensory rehabilitation for stroke survivors: a qualitative study to inform knowledge translation.

OBJECTIVES: Somatosensory loss is common after stroke with one-in-two individuals affected. Although clinical practice guidelines recommend providing somatosensory rehabilitation, this impairment often remains unassessed and untreated. To address the gap between guideline recommendations and clinical practice, this study sought to understand the factors influencing delivery of evidence-based upper limb sensory rehabilitation after stroke. DESIGN: Qualitative study involving focus groups and interviews. Data analysis used an inductive approach (thematic analysis) and deductive analysis using implementation theory (the Theoretical Domains Framework and Normalisation Process Theory). SETTING: Eight healthcare organisations in metropolitan and regional areas of Victoria and New South Wales, Australia. PARTICIPANTS: Eighty-seven rehabilitation therapists (79% occupational therapists and 21% physiotherapists) were purposively sampled and participated in a knowledge translation study with staggered recruitment from 2014 to 2018. RESULTS: Three types of factors influenced therapists' delivery of upper limb somatosensory rehabilitation: individual ('The uncertain, unskilled therapist'), patient ('Patient understanding and priorities') and organisational ('System pressures and resources'). Deductive analysis using implementation theory identified key determinants of practice change, such as opportunities to consolidate new skills, the anticipated benefits of upskilling as a therapy team and the work anticipated by therapists to incorporate a new somatosensory rehabilitation approach. CONCLUSIONS: Occupational therapists and physiotherapists hold valuable insights towards practice change in somatosensory rehabilitation from the 'frontline'. Therapists experience barriers to change including a lack of knowledge and skills, lack of resources and organisational pressures. Facilitators for change were identified, including social support and therapists' perceived legitimacy in using new somatosensory rehabilitation approaches. Results will inform the design of a tailored implementation strategy to increase the use of evidence-based somatosensory rehabilitation in Australia. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12615000933550).

Effectiveness of health consumer representative involvement in implementation of interventions to change health professional behaviour.

BACKGROUND: The adoption of research evidence to improve client outcomes may be enhanced using the principles of implementation science. This systematic review aimed to understand the effect of involving consumers to change health professional behaviours and practices. The barriers and enablers to consumer engagement will also be examined. METHODS: We searched Medline, CINAHL, Embase, the Cochrane Central Register of Controlled Trials and PDQ-Evidence from 2004 to February 2019. Implementation studies involving consumers in at least one phase (development, intervention or facilitation) of an intervention that aimed to change health professional behaviour to align with evidence-based practice were included. Studies in the areas of paediatrics and primary care were excluded. Two review authors independently screened studies for inclusion, and one author extracted data and conducted quality assessments with review of a second author. Knowledge translation interventions were categorized using the Effective Practice and Organisation of Care taxonomy. The primary outcome was measures of change in health professional behaviour. RESULTS: Sixteen articles met the inclusion criteria. Meta-analysis of three studies found support for consumer involvement in changing healthcare professionals' behaviour (Hedges' g = 0.41, 95% CI [0.27, 0.57], P < 0.001). Most knowledge translation studies involved consumers during the development phase only (n = 12). Most studies (n = 9) included one type of knowledge translation intervention. Professional interventions (including education of health professionals, educational outreach, and audit and feedback) were described in 13 studies. CONCLUSIONS: Consumer involvement rarely moves beyond the design phase of knowledge translation research in healthcare settings. Further research of the barriers to and effect of increased consumer engagement across all stages of knowledge translation interventions is needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019119179.

Implementation interventions to promote the uptake of evidence-based practices in stroke rehabilitation.

BACKGROUND: Rehabilitation based upon research evidence gives stroke survivors the best chance of recovery. There is substantial research to guide practice in stroke rehabilitation, yet uptake of evidence by healthcare professionals is typically slow and patients often do not receive evidence-based care. Implementation interventions are an important means to translate knowledge from research to practice and thus optimise the care and outcomes for stroke survivors. A synthesis of research evidence is required to guide the selection and use of implementation interventions in stroke rehabilitation. OBJECTIVES: To assess the effects of implementation interventions to promote the uptake of evidence-based practices (including clinical assessments and treatments recommended in evidence-based guidelines) in stroke rehabilitation and to assess the effects of implementation interventions tailored to address identified barriers to change compared to non-tailored interventions in stroke rehabilitation. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and eight other databases to 17 October 2019. We searched OpenGrey, performed citation tracking and reference checking for included studies and contacted authors of included studies to obtain further information and identify potentially relevant studies. SELECTION CRITERIA: We included individual and cluster randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies comparing an implementation intervention to no intervention or to another implementation approach in stroke rehabilitation. Participants were qualified healthcare professionals working in stroke rehabilitation and the patients they cared for. Studies were considered for inclusion regardless of date, language or publication status. Main outcomes were healthcare professional adherence to recommended treatment, patient adherence to recommended treatment, patient health status and well-being, healthcare professional intention and satisfaction, resource use outcomes and adverse effects. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. The primary comparison was any implementation intervention compared to no intervention. MAIN RESULTS: Nine cluster randomised trials (12,428 patient participants) and three ongoing trials met our selection criteria. Five trials (8865 participants) compared an implementation intervention to no intervention, three trials (3150 participants) compared one implementation intervention to another implementation intervention, and one three-arm trial (413 participants) compared two different implementation interventions to no intervention. Eight trials investigated multifaceted interventions; educational meetings and educational materials were the most common components. Six trials described tailoring the intervention content to identified barriers to change. Two trials focused on evidence-based stroke rehabilitation in the acute setting, four focused on the subacute inpatient setting and three trials focused on stroke rehabilitation in the community setting. We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence was very low (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.53 to 2.64; 2 trials, 39 clusters, 1455 patient participants; I2 = 0%). Low-certainty evidence indicates implementation interventions in stroke rehabilitation may lead to little or no difference in patient adherence to recommended treatment (number of recommended performed outdoor journeys adjusted mean difference (MD) 0.5, 95% CI -1.8 to 2.8; 1 trial, 21 clusters, 100 participants) and patient psychological well-being (standardised mean difference (SMD) -0.02, 95% CI -0.54 to 0.50; 2 trials, 65 clusters, 1273 participants; I2 = 0%) compared with no intervention. Moderate-certainty evidence indicates implementation interventions in stroke rehabilitation probably lead to little or no difference in patient health-related quality of life (MD 0.01, 95% CI -0.02 to 0.05; 2 trials, 65 clusters, 1242 participants; I2 = 0%) and activities of daily living (MD 0.29, 95% CI -0.16 to 0.73; 2 trials, 65 clusters, 1272 participants; I2 = 0%) compared with no intervention. No studies reported the effects of implementation interventions in stroke rehabilitation on healthcare professional intention to change behaviour or satisfaction. Five studies reported economic outcomes, with one study reporting cost-effectiveness of the implementation intervention. However, this was assessed at high risk of bias. The other four studies did not demonstrate the cost-effectiveness of interventions. Tailoring interventions to identified barriers did not alter results. We are uncertain of the effect of one implementation intervention versus another given the limited very low-certainty evidence. AUTHORS' CONCLUSIONS: We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence is very low.

Mentoring for knowledge translation in allied health: a scoping review protocol.

OBJECTIVE: The primary objective of this review is to identify how allied health staff have used mentoring as a knowledge translation strategy to support practice change. Secondary objectives include identifying barriers and enablers to using mentoring as a knowledge translation strategy, and the methods used to evaluate the strategy. INTRODUCTION: Mentoring provides professional support and guidance while attending to the learning needs of the individual. Mentoring has been described in previous knowledge synthesis reviews as a strategy for nursing and medicine practitioners to improve capability and capacity to participate in knowledge translation to create practice change. To the authors' knowledge, a synthesis of the use of mentoring as a knowledge translation strategy by allied health staff has not been reported. INCLUSION CRITERIA: This scoping review will consider all studies that describe the use of mentoring with allied health staff to support practice change as directed by research evidence. The scoping review will not investigate the use of mentoring to increase the conduct of research in a clinical setting, nor will studies be included if the majority of participants are students. METHODS: A three-step search strategy will be undertaken. Two independent authors will screen articles and perform data extraction. The results will be presented in a narrative Summary of Findings, alongside a presentation of the data in diagrammatic or tabular form. The findings will inform future use of mentoring as a knowledge translation strategy in a regional health service.

Task-specific training: evidence for and translation to clinical practice.

There is mounting evidence of the value of task-specific training as a neuromotor intervention in neurological rehabilitation. The evidence is founded in the psychology of motor skill learning and in the neuroscience of experience-dependent and learning-dependent neural plastic changes in the brain in animals and humans. Further, there is growing empirical evidence for the effectiveness of task-specific training in rehabilitation and for neural plastic changes following task-oriented training. In this paper, we position the evidence for task-specific training in the context of rehabilitation; review its relevance for occupation-based neurological rehabilitation, particularly in relation to upper limb function and everyday activities; and recommend evidence-driven strategies for its application. We recommend that task-specific training be routinely applied by occupational therapists as a component of their neuromotor interventions, particularly in management related to post-stroke upper limb recovery. Specifically, we propose five implementation strategies based on review of the evidence. These are: task-specific training should be relevant to the patient/client and to the context; be randomly assigned; be repetitive and involve massed practice; aim towards reconstruction of the whole task; and be reinforced with positive and timely feedback.