Evaluation of a staff behaviour change intervention to increase the use of ward-based practice books and active practice during inpatient stroke rehabilitation: a phase-1 pre–post observational study

Abstract

Objective: The aim of this study was to evaluate a staff behaviour change intervention to increase the use of ward-based practice books and active practice by stroke inpatients. Design: This is a pre–post observational study. Setting: This study was conducted in a inpatient rehabilitation unit in Australia. Subjects: Stroke inpatients participated in the study. Intervention: A staff behaviour change intervention was designed to support staff to implement practice books. The intervention included staff training on motivation and coaching, and weekly audit and feedback for six months. The environment was restructured to bring staff together weekly at the bedside to review audit data and share skills. Main measures: Medical record audit and behavioural mapping were used to compare the number of stroke participants with/using a practice book pre- and post-intervention. Pre- and post-intervention, the percentage of observations where a stroke participant was actively practising, repetitions of practice recorded and type of supervision were compared. Results: A total of 24 participants were observed ( n = 12 pre, n = 12 post). Post-intervention, the number of participants with practice books increased from one to six (OR = 11, 95% CI = (0.9, 550.7)), but this change was not statistically significant ( P = 0.069). Five participants recorded repetitions in their practice books post-intervention, three were observed using practice books. There was no change in median repetitions recorded ( rpbs = 0.00, 95% CI = (−0.4, 0.4), P = 1.000) or observed active practice ( rpbs = –0.02, 95% CI = (−0.4, 0.4), P = 0.933). Active practice was often fully supervised by a therapist. Conclusion: A staff behaviour change intervention has the potential to increase the number of stroke survivors receiving ward-based practice books but did not increase active practice.

Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals

“…This study has attempted to design a novel co-creation method through the integration of a co-production design framework with the BCW steps to co-create digital stories and apply it to identify core collective lessons through the synthesis of individual stroke survivors' experiences of interacting with healthcare professionals. Studies have shown the benefits of including stroke survivors and caregivers within the design process in order to develop more relevant and effective outcomes that emanate directly from the experiences of those who the intervention concerns most (65)(66)(67)(68). The design of this study has placed the input of stroke survivors at the center of the co-creation method, which has subsequently resulted in the synthesis of six important collective lessons that help to detail the presence of preconceptions and attitudes embedded within healthcare that may be negatively impacting survivors' healthcare experiences, and the need for survivors' individual lived experiences to be acknowledged to achieve a truly person-centered approach throughout the stroke pathway.…”

Implementation Strategies and Outcomes for Occupational Therapy in Adult Stroke Rehabilitation: A Scoping Review

“…The studies also frequently utilized discrete implementation strategies from the following two clusters: use evaluative and iterative strategies and develop stakeholder interrelationships. Seventeen studies implemented strategies in the evaluative and interactive strategies cluster (40,42,(44)(45)(46)(47)(48)(49)(51)(52)(53)(54)(55)(56)(57)(58)(59), with [4] Assess for readiness & identify barriers & facilitators being implemented the most within this cluster. Discrete strategies from the develop stakeholder relationships cluster were used in 12 studies (37,39,40,43,44,46,49,50,52,56,60,61), with [35] Identify & prepare champions being implemented the most with 7 studies (39,43,44,46,49,56,61).…”

“…Among the eight studies that implemented discrete strategies categorized in the support clinicians cluster, only two different discrete strategies were used. The strategy, [58] Remind clinicians, was almost exclusively used, with seven out of eight studies only implementing this strategy. The one remaining study utilized the discrete strategy [30] Develop resource sharing agreements.…”

“…The implementation outcome measured the most was adoption, which was evaluated in 21 out of 26 studies (36-38, 40-46, 48-50, 52, 54-56, 58-61). The second implementation outcome most frequently measured was delity with ten studies (41,42,47,50,51,53,55,57,58,60), as shown in Table 1. Fifteen studies measured two implementation outcomes, and eight studies measured one outcome.…”

“…Adapted from ERIC discrete implementation strategy compilation(27), ERIC strategy clusters(34), and taxonomy of implementation outcomes(28). ERIC strategy clusters: Use evaluative and iterative strategies(4,5,14,18,23,26,27,46,56,61), Provide interactive assistance (8, 33, 53, 54), Adapt and tailor to context (51, 63, 67, 68), Develop stakeholder interrelationships (6, 7, 17, 24, 25, 35, 36, 38, 40, 45, 47, 48, 52, 57, 64, 65, 72), Train and educate stakeholders(15,16,19,20,29,31,43,55,60, 71, 73), Support clinicians(21,30,32,58,59), Engage consumers(37,39,41,50,69), Utilize nancial strategies(1,2,3,28,34,42,49,66,70), and Change infrastructure(9,10, 11,12,13,22,…”