Abstract
BackgroundPatients with cognitive impairments following a stroke are often denied access to inpatient rehabilitation. The few patients with cognitive impairment admitted to rehabilitation generally receive services based on outdated impairment-reduction models, rather than recommended function-based approaches. Both reduced access to rehabilitation and the knowledge-to-practice gap stem from a reported lack of skills and knowledge regarding cognitive rehabilitation on the part of inpatient rehabilitation team members. To address these issues, a multi-faceted knowledge translation (KT) initiative will be implemented and evaluated. It will be targeted specifically at the inter-professional application of the cognitive orientation to daily occupational performance (CO-OP). CO-OP training combined with KT support is called CO-OP KT. The long-term objective of CO-OP KT is to optimize functional outcomes for individuals with stroke and cognitive impairments. Three research questions are posed:Is the implementation of CO-OP KT associated with a change in the proportion of patients with cognitive impairment following a stroke accepted to inpatient rehabilitation?Is the implementation of CO-OP KT associated with a change in rehabilitation clinicians’ practice, knowledge, and self-efficacy related to implementing the CO-OP approach, immediately following and 1 year later?Is CO-OP KT associated with changes in activity, participation, and self-efficacy to perform daily activities in patients with cognitive impairment following stroke at discharge from inpatient rehabilitation and at 1-, 3-, and 6-month follow-ups?Methods/DesignThree interrelated studies will be conducted. Study 1 will be a quasi-experimental, interrupted time series design measuring monthly summaries of stroke unit level data. Study 2, which relates to changes in health care professional practice and self-efficacy, will be a single group pre-post evaluation design incorporating chart audits and a self-report survey. Study 3 will assess patient functional outcomes using a non-randomized design with historical controls. Assessments will occur during admission and discharge from rehabilitation and at 1, 3, and 6 months following discharge from rehabilitation.DiscussionThis project will advance knowledge about the degree to which the implementation of a supported KT initiative can sustainably change health system, knowledge, and patient outcomes.
Highlights
Patients with cognitive impairments following a stroke are often denied access to inpatient rehabilitation
In the instances when they are admitted to inpatient stroke rehabilitation, they generally receive services based on outdated impairment-reduction models, rather than recommended function-based approaches [4]
Three outputs are expected: (1) increased proportion of patients with cognitive impairments admitted to inpatient stroke rehabilitation; (2) enhanced capacity of inter-professional stroke rehabilitation team members to implement a cognitive-strategy based treatment approach; and (3) improved immediate and long-term functional outcomes for patients with cognitive impairments discharged from inpatient stroke rehabilitation
Summary
This project will advance general knowledge about the degree to which the implementation of a supported, integrated, inter-professional KT initiative can sustainably change health system outcomes (access to rehabilitation), knowledge outcomes (rehabilitation team practice), and patient outcomes (functional improvement). It will advance knowledge about the degree to which changes can be sustained over the longer term through integrated KT mechanisms and committed partnerships with health and academic institutions. EL has contributed substantially to the protocol, to aspects related to the Toronto Stroke Networks. She has overseen the project development as a whole. Author details 1Sunnybrook Research Institute, Toronto, Canada.
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