Implementing a function-based cognitive strategy intervention within inter-professional stroke rehabilitation teams: Changes in provider knowledge, self-efficacy and practice

Abstract

BackgroundThe Cognitive Orientation to daily Occupational Performance (CO-OP) approach is a complex rehabilitation intervention in which clients are taught to use problem-solving cognitive strategies to acquire personally-meaningful functional skills, and health care providers are required to shift control regarding treatment goals and intervention strategies to their clients. A multi-faceted, supported, knowledge translation (KT) initiative was targeted at the implementation of CO-OP in inpatient stroke rehabilitation teams at five freestanding rehabilitation hospitals. The study objective was to estimate changes in rehabilitation clinicians’ knowledge, self-efficacy, and practice related to implementing CO-OP.MethodsA single arm pre-post and 6-month follow up study was conducted. CO-OP KT consisted of a 2-day workshop, 4 months of implementation support, a consolidation session, and infrastructure support. In addition, a sustainability plan was implemented. Consistent with CO-OP principles, teams were given control over specific implementation goals and strategies. Multiple choice questions (MCQ) were used to assess knowledge. A self-efficacy questionnaire with 3 subscales (Promoting Cognitive Strategy Use, PCSU; Client-Focused Therapy, CFT; Top-Down Assessment and Treatment, TDAT) was developed for the study. Medical record audits were used to investigate practice change. Data analysis for knowledge and self-efficacy utilized mixed effects models. Medical record audits were analyzed with frequency counts and chi-squares.ResultsSixty-five health care providers consisting mainly of occupational and physical therapists entered the study. Mixed effects models revealed intervention effects for MCQs, CFT, and PCSU at post intervention and follow-up, but no effect on TDAT. No charts showed any evidence of CO-OP use at baseline, compared to 8/40 (20%) post intervention. Post intervention there was a trend towards reduction in impairment goals and significantly more component goals were set (z = 2.7, p = .007).

Prediction of Motor Recovery in the Upper Extremity for Repetitive Transcranial Magnetic Stimulation and Occupational Therapy Goal Setting in Patients With Chronic Stroke: A Retrospective Analysis of Prospectively Collected Data

“…It is known that the effect of rehabilitation is enhanced when patients recognize the need to achieve their own goals and actively engage in pursuing them (37,38). In addition, patients who practice self-efficacy affect the recovery of the upper limb motor function (4).…”

Implementing a shared decision‐making and cognitive strategy‐based intervention: Knowledge user perspectives and recommendations

“…CO‐OP is an effective, cognitive strategy‐based treatment approach that aligns with Canadian Stroke Best Practice Recommendations. Using CO‐OP involves a shift from traditional rehabilitation practices that focus on clinician‐directed treatments, toward a person‐centered, collaborative approach wherein the patients' self‐selected functional goals are the focus of treatment . The patient is given a considerable degree of control over the treatment direction to successfully achieve those goals.…”

“…Using CO-OP involves a shift from traditional rehabilitation practices that focus on clinician-directed treatments, toward a personcentered, collaborative approach wherein the patients' self-selected functional goals are the focus of treatment. 7 The patient is given a considerable degree of control over the treatment direction to successfully achieve those goals. The rehabilitation team consults the patient and family to develop goals that are meaningful to the patient.…”

“…Details of the CO‐OP KT intervention have been previously published . In brief, it included a 2‐day training workshop with interprofessional teams of nurses, occupational therapists, physical therapists, speech language pathologists, and other disciplines, to establish the theory and application of the CO‐OP Approach in clinical practice.…”

“…, rec 5,7,8). suggested that practice change can be facilitated by basic CO-OP training for the full interprofessional team and related teams across the care continuum (eg, outpatient rehabilitation).…”