Understanding How Newly Implemented Rehabilitation Best Practices Are Sustained: A Realist Review

Ataman, Rebecca; Ahmed, Sara; Zidan, Ahlam; Thomas, Aliki

doi:10.1016/j.apmr.2022.05.016

Cited by 3 publications

(24 citation statements)

References 76 publications

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“…14 Stakeholders at all sites also suggested that the other five objectives are dependent on clinicians' continued ability to use the MPAI-4, a finding that mirrors the results of our realist review of the sustainability of newly implemented rehabilitation practices. 17 None of the other relationships between objectives highlighted by participants was similar to those discussed in previously published work (e.g., link between continued research and use in clinical decision-making). 14,17 Thus, shared sustainability objectives and the links between them seem to vary between EBPs, care settings (e.g., rehabilitation vs. cancer care), or by other contextual factors.…”

Section: Discussionmentioning

confidence: 86%

“…We used qualitative content analysis 46,58,59 supported by NVivo 12. 60 In a semi-structured meeting at Sites 2 and 3 based on the INESSS MPAI-4 implementation guide and the results of the realist review 17 we debriefed following the MPAI-4 pilot phase, updated implementation strategies accordingly and made associated changes to sustainability strategies. Site 1 opted out of this meeting.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to these core sustainability planning meetings, we held 108 follow-up meetings across the three sites (0. 54 The second was the realist review of sustainability in rehabilitation 17 which provided links between influential barriers and facilitators, and key sustainability strategies, that may be used to achieve specific sustainability outcomes.…”

Section: Sustainability Planning Processmentioning

confidence: 99%

“…In our recent realist review aimed at understanding the sustainability of newly implemented rehabilitation EBPs we found that only 54% of EBPs are sustained at least 6 months post-implementation. 17 While newly implemented EBPs should not always be sustained (e.g., when there is a need to replace an outdated practice), in many cases poor sustainment (e.g., reduced or non-use of an EBP) can result in negative consequences including wasted research and implementation funding, 18 and a loss of potential improvements in quality of care and patient outcomes. 19,20 Furthermore, poor sustainment may result in the loss of morale and a lack of willingness on the part of implementation team members to take part in future practice change projects.…”

Section: Introductionmentioning

confidence: 99%

“…In a semi-structured meeting based on the results of the data analysis completed thus far for this study and the results of our realist review, 17 we debriefed following the implementation of the new MPAI-4 BRILLIANT platform. We also used the results of the CSAT to refine the sustainability plan.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Collaborative sustainability planning for an outcome measure in outpatient stroke rehabilitation: A qualitative description study

Ataman,

Ahmed,

Berta

et al. 2024

Evaluation Clinical Practice

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RationaleEvidence suggests that sustainability planning and the use of a collaborative approach to planning result in better sustainability outcomes and more relevant knowledge. Yet, both approaches appear to be underutilized. A detailed description of collaborative sustainability planning may encourage the use of these two impactful strategies.Aims and ObjectivesTo explore the collaborative sustainability planning process for a single outcome measure in three rehabilitation sites.MethodologyWithin the Mayo‐Portland Adaptability Inventory—version 4 (MPAI‐4) implementation project, we conducted a qualitative description study. We used data from 12 core sustainability planning meetings and 108 follow‐up meetings that included a total of 31 clinical and research team participants. Sustainability planning was informed by an MPAI‐4‐specific implementation guide, and by the results from a realist review of the sustainability of rehabilitation practices and the Clinical Sustainability Assessment Tool. We analyzed qualitative data using thematic content analysis.ResultsThree themes describe the collaborative sustainability planning process: (1) “collaboration as a driver for sustainability” which captures the active collaboration underpinning sustainability planning; (2) “co‐creation of a sustainability plan to achieve shared objectives” which captures the identified barriers and facilitators, and selected sustainability strategies linked to one of six collaboratively identified shared objectives; and (3) “the iterative nature of sustainability planning” which captures the necessity of an agile and responsive sustainability planning process.ConclusionIdentified strategies may be useful to support (collaborative) sustainment. Future research could investigate the effect of collaborative sustainability planning on sustainability objectives, and the relationship between these objectives.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Sustainability Planning Processmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Collaborative sustainability planning for an outcome measure in outpatient stroke rehabilitation: A qualitative description study

Ataman,

Ahmed,

Berta

et al. 2024

Evaluation Clinical Practice

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Fostering the discussion of planetary health in occupational therapy and physiotherapy

Eustachio,

Filho,

Baars

et al. 2024

Aus Occup Therapy J

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IntroductionOccupational therapists and physiotherapists aim to promote health, prevent various diseases and help people in their rehabilitation processes. So far, there is a paucity of understanding of the big picture of how the new paradigm of planetary health (PH) is connected to the education and practice of these professionals.MethodsThis research aimed to address this gap by investigating and deploying a bibliometric analysis to elucidate the pivotal role of occupational therapists and physiotherapists in addressing PH challenges. The ultimate goal is to construct a comprehensive framework crosschecking the bibliometric analysis and the collection of 10 case studies selected by experts to outline how best practices in occupational therapy and physiotherapy, related to the three pillars of sustainability and the UN's Sustainable Development Goals (SDGs), can contribute to increasing PH.ResultsThe bibliometric analysis revealed four major research strands: 1) enhancing patient care and quality of life; 2) integrating sustainability in health care and rehabilitation; 3) professional development and clinical competence; and 4) evidence‐based practice and quality improvement. Moreover, further temporal analysis revealed how the topic evolved, from advancing evidence‐based practice and clinical effectiveness, exploring the strengthening of health care and person‐centred practices, to connecting the topic to aspects also predicted by the SDGs, such as integrating environmental and climate concerns in therapy and addressing psychological and self‐care impacts on health. The case studies confirmed this trend, and a framework of PH in occupational therapy and physiotherapy through the lens of the SDGs was developed to support future research and practitioners in advancing this research field.ConclusionsOccupational therapists and physiotherapists are essential players in public health and can integrate sustainability at every level of practice, from using resources during therapy sessions to advocating for more sustainable lifestyles.

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Sustainability of an outcome measure in outpatient stroke rehabilitation: A realist evaluation

Ataman,

Ahmed,

Berta

et al. 2024

Evaluation Clinical Practice

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RationaleOnly half of newly implemented evidence‐based practices are sustained. Though poor sustainment can lead to negative consequences for clinical teams, organizations and patients, the causal explanations of sustainment are largely unknown.Aims and ObjectivesWe aimed to ascertain how (mechanisms) and in what circumstances (context) a newly implemented outcome measure in rehabilitation was sustained or not (outcome).MethodologyInformed by an integrated knowledge translation approach, we conducted a realist evaluation using a mixed method, embedded single case study design with data collection up to 18 months following the implementation of the Mayo‐Portland Adaptability Inventory ‐ version 4 (MPAI‐4), a rehabilitation outcome measure. Quantitative data (survey and patient charts) was analysed using descriptive statistics, then integrated with qualitative data (interviews with 10 key informants) and analysed using inductive and deductive retroduction. We integrated the data to develop a case description and ultimately, to refine the programme theory to better understand the sustainability of the MPAI‐4.ResultsWe linked context, mechanisms and outcomes, and also emphasized sustainability strategies in 18 explanations of how sustainability works. These explanations provide evidence for four overarching patterns: (1) implementation and sustainability phases are interconnected, (2) outcomes build on each other recursively, with patient benefits as the keystone outcome, (3) sustainment is achieved to varying levels across different sustainability outcomes [e.g., high level (e.g., rate of MPAI‐4 scoring: 77.7%) to low level (e.g., rate of MPAI‐4 application to clinical decision‐making: 3.7%)] and (4) the work of sustaining the MPAI‐4 is shared amongst different stakeholders.ConclusionImplementation teams can draw from this programme theory to improve the sustainment of outcomes measures while researchers could continue to refine the theory. Continued investigation of sustainability, including diverse and continuous sustainability outcomes, is needed to understand how to maintain improvements in quality of care and patient outcomes.

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Understanding How Newly Implemented Rehabilitation Best Practices Are Sustained: A Realist Review

Cited by 3 publications

References 76 publications

Collaborative sustainability planning for an outcome measure in outpatient stroke rehabilitation: A qualitative description study

Collaborative sustainability planning for an outcome measure in outpatient stroke rehabilitation: A qualitative description study

Fostering the discussion of planetary health in occupational therapy and physiotherapy

Sustainability of an outcome measure in outpatient stroke rehabilitation: A realist evaluation

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