Implementation strategies and outcomes for occupational therapy in adult stroke rehabilitation: a scoping review

Abstract

Background Stroke survivors often encounter occupational therapy practitioners in rehabilitation practice settings. Occupational therapy researchers have recently begun to examine the implementation strategies that promote the use of evidence-based occupational therapy practices in stroke rehabilitation; however, the heterogeneity in how occupational therapy research is reported has led to confusion about the types of implementation strategies used in occupational therapy and their association with implementation outcomes. This review presents these strategies and corresponding outcomes using uniform language and identifies the extent to which strategy selection has been guided by theories, models, and frameworks (TMFs). Methods A scoping review protocol was developed to assess the breadth and depth of occupational therapy literature examining implementation strategies, outcomes, and TMFs in the stroke rehabilitation field. Five electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting the inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer to achieve consensus. The 73-item Expert Recommendations for Implementing Change (ERIC) implementation strategy taxonomy guided the synthesis of implementation strategies. The Implementation Outcomes Framework guided the analysis of measured outcomes. Results The initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were described in the included studies. The most used implementation strategies were “distribute educational materials” (n = 11), “assess for readiness and identify barriers and facilitators” (n = 11), and “conduct educational outreach visits” (n = 10). “Adoption” was the most frequently measured implementation outcome, while “cost” was not measured in any included studies. Eleven studies reported findings supporting the effectiveness of their implementation strategy or strategies; eleven reported inconclusive findings, and four found that their strategies did not lead to improved implementation outcomes. In twelve studies, at least partially beneficial outcomes were reported, corresponding with researchers using TMFs to guide implementation strategies. Conclusions This scoping review synthesized implementation strategies and outcomes that have been examined in occupational therapy and stroke rehabilitation. With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the use of evidence-based practices in routine stroke care and describe those strategies, as well as associated outcomes, using uniform nomenclature. Doing so could advance the occupational therapy field’s ability to draw conclusions about effective implementation strategies across diverse practice settings.

An analysis of clinical outcomes and essential parameters for designing effective games for upper limb rehabilitation: A scoping review

“…To synthesize data, we used the progression bounding method recommended by Levac et al, 38 Since scoping reviews do not summarize or measure evidence from studies, 38,39 in our study only descriptive analyses (such as frequency and percentage) were performed on the extracted data to describe the findings of the included studies. 40 The descriptive data and findings of all included articles were organized in the format of tables and figures based on themes to present the findings of the present study, which guided the objectives of the study. In case of disagreement by any of the authors, the final decision about each figure or table was reached through discussion.…”

“…Our review found games can cause “Improvement in musculoskeletal performance,” “Increasing users' enjoyment/joy of therapeutic exercises and their motivation to perform these exercises,” “Therapy compliance and acceptability by patients,” and “Increasing adherence to treatment and performing rehabilitation exercises.” Some review studies 4,40 also showed that virtual reality and rehabilitation games can increase the patient's motivation to perform exercises, improve upper limb function, improve independence in day‐to‐day activities, and improve upper limb range of motion, as well as strengthen neural connections and cause reorganization in different areas of the cerebral cortex related to the injured limb, leading to improved motor performance 59 . Virtual reality‐based games boost motor learning.…”

Perspective Chapter: Clinical Standard of a Geriatric Patient as a Virtual Target for Correction of Pharmacotherapy of Hypertension and Stroke in the Elderly

“…The results they obtained allowed them to highlight the most effective methods and procedures. In particular, based on the experience of comprehensive rehabilitation of the masticatory-speech apparatus impaired in patients as a result of stroke and craniocerebral trauma, neurologists gave preference to the method of restorative training of patients [29][30][31].…”

Implementing Smoking Cessation Interventions for Tobacco Users Within Oncology Settings

“…Common strategies include training, educating, audit, and feedback, including engagement with stakeholders (clinicians, executive boards, community services, academic partnerships, and policy makers). A discrete group of strategies have been identified through codesign and scoping reviews to promote practice guideline implementation in hospital settings, and form the basis for understanding the mechanisms of change when developing implementation trials . For sustained use and lasting change, a recent review of research in hospital-based smoking cessation interventions emphasizes the use of multiple strategies.…”