None listed
Conditions
Brief summary
This project will use a cluster randomised trial design to assess the effectiveness of an implementation program designed to increase proportions of patients with stroke receiving a documented assessment for rehabilitation. Hospitals (clusters) will be randomly assigned to receive a multifaceted intervention or an education-only intervention. The multifaceted intervention consists of a decision-making tool, education, audit and feedback, reminders and a tailored implementation package consisting of identification of barriers and facilitators and development of site-specific strategies for implementation (identified in a workshop with health professionals as participants) to help improve rehabilitation assessment practices. The education-only intervention consists of a single education session and provision of a decision-making tool. Observations will be conducted at sites assigned to the multifaceted intervention to observe how assessment are occurring prior to the intervention prior to the intervention. Focus groups will be held at all sites after the implementation period to explore how staff assess and refer patients with stroke for rehabilitation Medical records will be audited pre- and post-intervention at all hospitals to assess proportions of patients assessed for rehabilitation, and proportions of patients who access rehabilitation.
Interventions
Multifaceted behaviour change intervention for health professionals working in acute stroke units. All sessions conducted onsite at acute hospitals. Comprised of
1. education sessions: Two education sessions delivered onsite to acute stroke unit team by research physiotherapist (>10 years clinical experience). Both education sessions (duration 30-60 minutes) held within a 1 month period, participants were invited to attend both sessions. Education regarding Assessment for Rehabilitation Tool (r
Multifaceted behaviour change intervention for health professionals working in acute stroke units. All sessions conducted onsite at acute hospitals. Comprised of 1. education sessions: Two education sessions delivered onsite to acute stroke unit team by research physiotherapist (>10 years clinical experience). Both education sessions (duration 30-60 minutes) held within a 1 month period, participants were invited to attend both sessions. Education regarding Assessment for Rehabilitation Tool (rationale for use, how to use) provided. Up to 3 additional education sessions provided if this was nominated as a strategy by participants in the strategy development workshop 2. Printed educational materials: paper copies of the Assessment for Rehabilitation Tool, and 3 copies of Assessment for Rehabilitation Tool user manual provided to acute stroke unit teams. Information provided regarding freely available associated electronic resources 3. Audit and feedback: medical record audit conducted by research physiotherapist, site-specific feedback provided verbally and written (paper-version) summary of audit distributed to participants working on acute stroke unit by research PT re proportions of patients assessed for rehabilitation, profiles of patients not assessed in audit, profiles of professionals who conducted the assessments in the audit, summary of assessment processes and access to rehabilitation 4. barrier identification and strategy development: workshops held with acute stroke unit team at each site (facilitated by research physiotherapist) to identify barriers to use of Assessment for Rehabilitation Tool, followed immediately by strategy development session (combined session 60 minute duration) 5. Site champions: each site nominated 1-3 site champions to lead implementation of strategies developed in workshop 6. reminders: 1-2 emails sent to all workshop participants by research PT regarding strategies developed to use Assessment for rehabilitation Tool. Monthly phone or email contact between research PT and site champion for 4 months following initial education session (more contact if initiated by site champion) to discuss implementation of strategies. Records kept by research PT re which health professionals attended education sessions and strategy development workshop
Sponsors
University of South Australia
Study design
Allocation
Randomised controlled trial
Primary purpose
Educational / counselling / training
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
For medical record audit: Admitted to hospital with stroke To be included in interventions and focus groups: health professional working on acute stroke unit
Exclusion criteria
For medical record audit: No signs of stroke on admission to hospital, receiving palliative care, transferred to another hospital for acute management/investigation
Outcome results
None listed