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).
Highlights
While it is well established that implementing even a relatively simple practice change can be challenging, few studies have examined the implementation of a complex intervention in inter-professional, multi-site environments
The overall aim of this study was to estimate changes in rehabilitation clinicians’ knowledge, self-efficacy, and practice related to implementing a complex, client-centred, cognitive-strategy-based treatment approach following the multi-faceted knowledge translation (KT) initiative known as Cognitive Orientation to daily Occupational Performance (CO-OP) KT
In addition to the formal CO-OP KT program (2-day workshop, implementation support, consolidation session, infrastructure support), we developed a sustainability plan that was put into action after the formal CO-OP KT intervention period had ended
Summary
While it is well established that implementing even a relatively simple practice change can be challenging, few studies have examined the implementation of a complex intervention in inter-professional, multi-site environments. A multi-faceted, supported, knowledge translation (KT) initiative, targeted at the inter-professional application of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach in inpatient stroke rehabilitation teams at five freestanding rehabilitation hospitals [4] was implemented and evaluated. The project, called CO-OP KT, has three embedded studies related to client outcomes; provider knowledge, self-efficacy, and practice; and health system level changes in access to inpatient rehabilitation for persons with cognitive impairments. The 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
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