Strategies to Promote Implementation of Standardized Assessments in Stroke Rehabilitation
Despite the availability of standardized assessments in stroke rehabilitation, occupational therapy (OT) practitioners do not routinely implement these assessments in real-world practice. In response to this knowledge-to-practice gap, rehabilitation researchers and clinicians teamed up to optimize the implementation of standardized assessments – the Fugl-Meyer Assessment and Action Research Arm Test – with stroke survivors in the acute, inpatient, and outpatient stroke rehabilitation at The Ohio State University Wexner Medical Center.
Step 1: Conduct needs assessment. Key informants (three OTs, one physical therapist, and three rehabilitation administrators) indicated that the Fugl-Meyer Assessment and Action Research Arm Test were important to implement across the rehabilitation continuum; however, targeted efforts were needed to overcome barriers to assessment implementation. Our research team conducted a scoping review to understand these implementation barriers specific to stroke rehabilitation and OT. We applied the Consolidated Framework for Implementation Research (CFIR) and identified three main barriers: a lack of access to knowledge and information, limited communication networks, and unsupportive implementation culture.
Step 2: Select and tailor implementation strategies. Our team entered our three main implementation barriers into the CFIR-ERIC (Expert Recommendations for Implementing Change project) matching tool, which recommended we deploy the following strategies to overcome implementation barriers: conduct educational meetings, create a learning collaborative, and identify and prepare champions. We further vetted these strategies in formal focus groups with OT practitioners in acute, inpatient, and outpatient rehabilitation settings. They requested three additional implementation strategies to support the Fugl-Meyer Assessment and Action Research Arm Test use: develop (web-based) educational materials, provide necessary equipment, and change record systems.
Step 3: Deploy implementation strategies. We have deployed the following strategies as of April 2022: Appointing one assessment “champion” at each setting (e.g., acute, inpatient, outpatient) to serve as a liaison between the project team and frontline OTs; providing all OTs with necessary equipment to implement both the Fugl-Meyer Assessment and Action Research Arm Test; collaborating with the information technology (IT) department to change electronic medical records allowing for streamlined documentation of assessments in stroke survivors’ medical charts; conducting in-person training with OTs (n = 26); and providing e-training materials.
Step 4: Evaluate strategies. Our team is collaborating with the rehabilitation IT department to pull monthly chart data and determine the extent to which our implementation strategies improve the use of standardized assessments by OT practitioners. Our goal is to improve assessment use from 3.5% to 85% across the stroke continuum by August 2023.
Applied LeaRRning Case
Lisa Juckett, PhD, OTR/L, CHT, is an Assistant Professor of Occupational Therapy at The Ohio State University. This Applied LeaRRning Case is based on Dr. Juckett’s LeaRRn Grand Rounds presentation, “Identifying Contextual Determinants & Implementation Strategies: Stakeholder Engaged Initiatives to Improve Rehabilitation Research and Practice.” In her presentation, Dr. Juckett reviews her team’s process of evaluating determinants of standardized assessment use in stroke rehabilitation and showcases strategies to support assessment uptake across the rehabilitation continuum.
“As rehabilitation researchers and clinicians, we must ensure that our implementation strategies are purposely designed to overcome implementation barriers.”
Lisa Juckett, PhD, OTR/L, CHT