Implementation of Standardized Outcome Measures for Motor Function in a Neurorehabilitation Hospital

Abstract

International guidelines recommend the use of standardized outcome measures post-stroke. The aim of this study was to delineate and evaluate the implementation of four motor function outcome measures. This study describes the application of a multifaceted strategy that integrates various approaches to augment implementation. The study was conducted among physical therapists in a sub-acute neurorehabilitation hospital. The implementation process was guided by the Knowledge-to-Action Cycle, and a taxonomy for implementation outcomes was systematically employed to analyze and evaluate the implementation process. Focus group interviews were conducted both prior and 6 months subsequent to an implementation period. Additionally, data from healthcare records were extracted to monitor the penetration of the new procedures. All 70 employed physical therapists underwent training on the application of the four selected outcome measures. Barriers identified in the focus group interviews encompassed perceived acceptability and appropriateness of the outcome measures, time consumption for testing, and perceived lack of relevance for certain patients. These barriers were mitigated through local adaptions. However, 6 months post-implementation, the adoption and penetration of the new procedures were only partially satisfactory. Some physical therapists still expressed reluctance toward employing outcome measures, and findings from the healthcare records corroborated the interview results. Specifically, adherence to testing procedures surpassed the pre-defined threshold of 75% for only one outcome measure at one pre-defined time point. A persistent effort is required to enhance acceptability, adoption, penetration, and to ensure the sustainability of the new procedures.