Delivering Intensive Rehabilitation in Stroke: Factors Influencing Implementation

Abstract

Even therapists involved in delivering a high-intensity intervention as part of a trial wanted to adapt it for clinical practice; therefore, it is imperative that researchers are explicit regarding key intervention components and what can be adapted to help ensure implementation fidelity. Changes in therapists' beliefs and system-level changes (staffing and resources) are likely necessary to facilitate higher-intensity rehabilitation in practice.

Why allied health professionals use evidence-based clinical guidelines in stroke rehabilitation: A systematic review and meta-synthesis of qualitative studies

“…The study characteristics for the 22 included studies are presented in Table 1. The studies originated from seven different countries: nine from Australia, 21–27 seven from Canada, 28–34 two from the United Kingdom, 35,36 one from Norway 37 one from Ireland, 38 one from New Zealand 39 and one from the Netherlands. 40 There was a total of 850 included participants comprised of 371 speech language pathologists, 356 physiotherapists, 100 occupational therapists, four dieticians, five rehabilitation assistants/therapy assistants, two social workers and one psychologist.…”

“…The appraisal findings were limited to what was reported in the studies. Only eight studies reported that sampling occurred until data saturation was reached 22,30–33,37,40,41 and five needed to provide more information about the locations for data collection. 30–32,39,40 Explanation of the role of researchers and their biases and assumptions were missing in seven studies.…”

“…Only eight studies reported that sampling occurred until data saturation was reached 22,30–33,37,40,41 and five needed to provide more information about the locations for data collection. 30–32,39,40 Explanation of the role of researchers and their biases and assumptions were missing in seven studies. 28,29,34,36–39 Details of data analysis were usually described well but only 13 studies reported that an audit trail of analytic decisions was kept.…”

“…They reported that time constraints decreased use of guidelines, 39 particularly as they had other responsibilities besides direct time with clients (see Table 2, Theme 1, quote from Petzold et al). 33 They needed to account for ‘ so many variables ’ (p. 515), 21,25,29,30,39,41 and were spread so thinly that sometimes they only had time for assessments rather than interventions. 26,33 Some interventions were essential (such as ‘ practis[ing] stairs, do[ing] a home visit ’ ) which left no time for other therapies (p. 247).…”

Perspectives on the prospective development of stroke-specific lower extremity wearable monitoring technology: a qualitative focus group study with physical therapists and individuals with stroke

“…One avenue to target walking for individuals with stroke may be to utilize wearable monitoring technology, as previous research has shown that application of an activity monitor can improve user self-efficacy and physical activity levels in various patient populations including older adults, breast cancer survivors, and those with chronic obstructive pulmonary disease [7][8][9][10][11]. Additionally, wearable monitors have been increasingly utilized by therapists and researchers to assess various outcomes relating to exercise and physical activity, [12,13] within therapy and between visits, to ensure exercise targets are met [14].…”