Effects of an Educational Intervention on Rehabilitation Clinicians' Practices for Health-related Outcomes After Stroke

Not Applicable

• Conditions: Knowledge, Attitudes, Practice; Physical Disability; Motor Skills Disorders; Stroke
• Interventions: Other: Implementation of stroke mobility guidelines

• Registration Number: NCT03807115
• Lead Sponsor: McGill University

Brief Summary

The overall aim of this pilot study is to evaluate the feasibility of a study protocol for a future stepped wedge cluster randomized clinical trial (c-RCT) that will investigate the effects of an innovative KT intervention on 1) walking capacity and independence in ADL in patients undergoing rehabilitation after stroke (patient outcomes); and 2) clinicians' practice (i.e. use of 4 evidence-based stroke rehabilitation interventions: motor imagery/mental practice, rhythmic auditory stimulation gait therapy, task oriented training including fitness and mobility exercises and aerobic training) (provider outcome) aimed at improving walking capacity. The specific objectives are: 1) To evaluate the feasibility (effectiveness of clinician recruitment strategies, extent of losses to follow-up across sites, and data analysis plans) of the study protocol in terms of methodology (stepped wedge design is an innovative methodology); 2) To estimate intervention effect sizes on study outcomes (patient and clinician); 3) To evaluate the secondary outcome (clinicians' use of the 4 interventions) with regard to reliability and validity.

Detailed Description

Walking capacity is the major priority for patients after stroke. Strong research evidence shows that walking capacity can be improved by rehabilitation interventions such as motor imagery, rhythmic auditory cueing, task-oriented training and aerobic exercise. Despite strong evidence for the effectiveness of these interventions on walking capacity, many clinicians (occupational therapists (OTs) and physical therapists (PTs)) do not use these in their practice. This knowledge translation (KT) pilot study aims to support evidence-based practice amongst rehabilitation clinicians working in stroke rehabilitation and collect data to inform a future larger clinical trial that will investigate if having repeated exposure to an innovative KT intervention will: increase clinicians' use of four targeted rehabilitation interventions (listed above) and positively affect walking capacity and independence in daily activities in patients after stroke. The investigators will recruit 2-3 OTs and 2-3 PTs per site from 6 major inpatient stroke rehabilitation centres across Canada to participate in a KT intervention consisting of an interactive and readily accessible web-based platform to deliver evidence-based knowledge on 4 rehabilitation interventions targeting walking capacity. This will be done via email in short online educational capsules including strategies for implementing the interventions and tools to promote reflection on current and future practice. They will then ask clinicians for feedback on: 1) the value of the knowledge delivered via email; 2) their perceptions about the success of using the guidelines with specific stroke patients; 3) the barriers they experienced when using the platform; and 4) the actual benefits for their patients. Through this innovative KT intervention, clinicians will have an opportunity to reflect upon and subsequently modify their practice to include evidence-based interventions known to improve walking capacity and functional independence.

Study Timeline

• Study First Submitted: 2018-12-21
• Study First Submitted QC: 2019-01-14
• Study First Posted: 2019-01-16
• Study Start: 2020-02-24
• Status Verified: 2021-02
• Last Update Submitted: 2021-02-22
• Last Update Posted: 2021-02-23
• Primary Completion: 2021-10-15
• Study Completion: 2021-12-31

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 37

Inclusion Criteria

• Occupational therapists and physical therapists with a minimum of 1 year clinical experience, working in an in-patient stroke rehabilitation centre in Canada.
• Sites will be eligible if they do not have an existing format knowledge translation initiative directed at enhancing practice in mobility training, have at least 10 people with stroke on their unit on a regular basis, and have an interdisciplinary team consisting of 2-3 occupational therapists and 2-3 physical therapists.
• Patients with a documented walking deficit (documented in patient's chart) and which are on the caseload of a minimum of one participating clinician.

Exclusion Criteria

• Occupational or physical therapists who are currently participating in another knowledge translation study directed at enhancing practice in mobility training.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Intervention	Implementation of stroke mobility guidelines	Arm: Intervention: Implementation of stroke mobility guidelines

Primary Outcome Measures

Name	Time	Method
Six minute walk test (walking ability)	1-3 months	Measurement of the total distance walked over six minutes on a hard, flat surface
Functional Ambulation Category	1-3 months	6-point measurement of functional ambulation (0=nonfunctional ambulation; 5=ambulator independent)
Functional Independence Measure	1-3 months	7-level measurement of functional independence (1=total assist; 7=complete independence)

Secondary Outcome Measures

Name	Time	Method
Information Assessment Method	1-3 months	Clinician-reported feedback on weekly delivery and retrieval of health information provided in educational capsules
Clinician-reported feedback on caseload (Calculation of Indicators)	1-3 months	Number of patients with stroke treated per week
Clinician-reported feedback on delivery of interventions (Calculation of Indicators)	1-3 months	Duration of interventions delivered per stroke patient per week (in 5 minute increments)
Clinician-reported feedback on confidence level in ability to deliver interventions (Calculation of Indicators)	1-3 months	Confidence level in ability to deliver interventions on 10-point scale (0=not at all confident; 10=extremely confident)
My Guidelines Implementation Barometer	1-3 months	Clinician-reported feedback on application of guideline recommendations in clinical practice, barriers to implementation and expected health benefits. Clinicians will be asked to list the factors that influenced the use of those recommendations in their practice.

Trial Locations

Locations (6)

Nanaimo General Hospital; 🇨🇦 Nanaimo, British Columbia, Canada

Wascana Rehabilitation Centre; 🇨🇦 Regina, Saskatchewan, Canada

Riverview Health Centre; 🇨🇦 Winnipeg, Manitoba, Canada

Nova Scotia Health Authority; 🇨🇦 Halifax, Nova Scotia, Canada

St. John's Rehab - Sunnybrook Hospital; 🇨🇦 North York, Ontario, Canada

Bridgepoint Rehabilitation Hospital; 🇨🇦 Toronto, Ontario, Canada