A formative evaluation of the implementation of an upper limb stroke rehabilitation intervention in clinical practice: a qualitative interview study

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• 作者：Louise A Connell (1)
  Naoimh E McMahon (1)
  Jocelyn E Harris (2)
  Caroline L Watkins (1)
  Janice J Eng (3)
  
  1. Clinical Practice Research Unit ; School of Health ; University of Central Lancashire ; Preston ; PR1 2HE ; UK
  2. School of Rehabilitation Science ; McMaster University ; 1400 Main Street West ; Hamilton ; Ontario ; L8S 1C7 ; Canada
  3. Department of Physical Therapy ; University of British Columbia ; 212-2177 Wesbrook Mall ; Vancouver ; V6T 1Z3 ; British Columbia ; Canada
  
• 刊名：Implementation Science
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：9
• 期：1
• 全文大小：262 KB
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• 刊物主题：Health Promotion and Disease Prevention; Health Administration; Health Informatics;
• 出版者：BioMed Central
• ISSN：1748-5908

文摘

Background The Graded Repetitive Arm Supplementary Program (GRASP) is a hand and arm exercise programme designed to increase the intensity of exercise achieved in inpatient stroke rehabilitation. GRASP was shown to be effective in a randomised controlled trial in 2009 and has since experienced unusually rapid uptake into clinical practice. The aim of this study was to conduct a formative evaluation of the implementation of GRASP to inform the development and implementation of a similar intervention in the United Kingdom. Methods Semi-structured interviews were conducted with therapists who were involved in implementing GRASP at their work site, or who had experience of using GRASP. Normalisation Process Theory (NPT), a sociological theory used to explore the processes of embedding innovations in practice, was used to develop an interview guide. Intervention components outlined within the GRASP Guideline Manual were used to develop prompts to explore how therapists use GRASP in practice. Interview transcripts were analysed using a coding frame based on implementation theory. Results Twenty interviews were conducted across eight sites in British Columbia Canada. Therapists identified informal networks and the free online availability of GRASP as key factors in finding out about the intervention. All therapists reported positive opinions about the value of GRASP. At all sites, therapists identified individuals who advocated for the use of GRASP, and in six of the eight sites this was the practice leader or senior therapist. Rehabilitation assistants were identified as instrumental in delivering GRASP in almost all sites as they were responsible for organising the GRASP equipment and assisting patients using GRASP. Almost all intervention components were found to be adapted to some degree when used in clinical practice; coverage was wider, the content adapted, and the dose, when monitored, was less. Conclusions Although GRASP has translated into clinical practice, it is not always used in the way in which it was shown to be effective. This formative evaluation has informed the development of a novel intervention which aims to bridge this evidence-practice gap in upper limb rehabilitation after stroke.