Importance: Despite advancements in stroke rehabilitation research, occupational therapy practitioners still face challenges with implementing research into routine practice. Although the development of evidence-based practices (EBPs) is one critical step along the knowledge translation continuum for the population of people with stroke, research is also needed to identify the most effective strategies for implementing EBPs with stroke survivors who are receiving occupational therapy services. Objective: To synthesize research related to occupational therapy practitioners’ implementation of EBPs in adult stroke rehabilitation. Data Sources: We searched four electronic databases—CINAHL, MEDLINE, PubMed, and Academic Search Complete—and the peer-reviewed journal Implementation Science to identify relevant research studies. Study Selection and Data Collection: Studies that met the following inclusion criteria were included in the scoping review: published between January 2003 and January 2018, addressed the adult stroke population, and examined the implementation of occupational therapy interventions. Data were abstracted on the basis of recommendations from the seminal review framework established by Arksey and O’Malley (2005). Thematic analysis identified themes that emerged from the included studies. Findings: Twenty-five articles satisfied our inclusion parameters. Our analyses yielded three overarching themes: barriers to implementation, facilitators of implementation, and implementation strategies. Implementation strategies often consisted of multimodal knowledge translation training programs. Conclusion and Relevance: Although the stroke rehabilitation literature appears to have established the barriers to and facilitators of EBP implementation, greater attention to the identification of effective implementation strategies that promote the uptake of EBPs by occupational therapy practitioners is needed. What This Article Adds: This article summarizes the contextual factors and effective strategies that may influence practitioners’ implementation of stroke research findings in real-world practice.
Clear reporting on rehabilitation treatments is critical for interpreting and replicating study results and for translating treatment research into clinical practice. This article reports the recommendations of a working group on improved reporting on rehabilitation treatments. These recommendations are intended to be combined with the efforts of other working groups, through a consensus process, to arrive at a reporting guideline for randomized controlled trials in physical medicine and rehabilitation (Randomized Controlled Trials Rehabilitation Checklist). The work group conducted a scoping review of 156 diverse guidelines for randomized controlled trial reporting, to identify themes that might be usefully applied to the field of rehabilitation. Themes were developed by identifying content that might improve or enhance existing items from the Template for Intervention Description and Replication. Guidelines addressing broad research domains tended to define reporting items generally, from the investigator’s perspective of relevance, whereas those addressing more circumscribed domains provided more specific and operationalized items. Rehabilitation is a diverse field, but a clear description of the treatment’s separable components, along with distinct treatment theories for each, can improve reporting of relevant information. Over time, expert consensus groups should develop more specific guideline extensions for circumscribed research domains, around coalescing bodies of treatment theory.
Despite advancements in occupational therapy research, the widespread research-to-practice gap continues to delay how quickly evidence-based practices are implemented in real-world clinical settings. Implementing research in practice is a complex process that mandates attention from all occupational therapy stakeholders; however, researchers are uniquely positioned to help minimize the 17-yr lag between scientific discovery and the implementation of research findings into practice. Our article serves as a response to Marr's (2017) Centennial Topics article, which proposed that purposeful efforts are needed to advocate for implementation research in occupational therapy. We provide an implementation science research agenda informed by concepts from the implementation science literature and suggest how researchers can structure methodologies to examine implementationrelated outcomes and strategies. We provide explanations of gold-standard implementation outcomes and offer several recommendations for how researchers can report and disseminate implementation research findings to occupational therapy stakeholders.
Prosthetics and orthotics have been recognized for decades as a potential means to restore hand function and independence to individuals living with impairment due to stroke. However, 75% of stroke survivors, caregivers, and health care professionals (HCP) believe current practices are insufficient, specifically calling out upper extremity as an area where innovation is needed to develop highly usable prosthetics/orthotics for the stroke population. A promising method for controlling upper limb prosthetics is to infer movement intent non-invasively from electromyography (EMG) activity. While this approach has garnered significant attention in the literature, existing technologies are often limited to research settings and struggle to meet stated user needs. To address these limitations, we have developed the NeuroLife® EMG System which consists of a wearable garment, similar to a compression sleeve, worn on the forearm with 150 embedded electrodes spread across the forearm, and associated hardware and software to record and decode high-resolution surface EMG. We demonstrate that the NeuroLife EMG System can accurately decode 12 functional hand, wrist, and forearm movements, including multiple types of grasps from participants with varying levels of impairment, with an overall accuracy of 77.1±5.6% in ideal scenarios and 74.7±5.0% in simulated real-time situations. Importantly, we demonstrate the ability to decode movements that participants are unable to overtly perform, showing potential as a control mechanism for assistive technologies. Feedback from stroke survivors who tested the system indicates that the design of the sleeve meets various user needs including being comfortable, portable, and lightweight. The sleeve is in a form factor such that it can be used at home without an expert technician, can be donned with the help of a caretaker, and can be worn for multiple hours without discomfort. Taken together, the NeuroLife EMG System represents a platform technology to record and decode high-definition electromyography for the real-time control of assistive devices in a form factor designed to meet user needs.
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