Knowledge Translation Interventions; which are most effective in upper limb rehabilitation?

Group A received the facilitator mediated implementation package. Group B received the self-directed implementation package group. The Control Group received usual care (no intervention for implementation of the guidelines beyond access to the guidelines or usual continuing professional development). Group A, the facilitator mediated implementation package group received: point of care videos, face to face education sessions (45mins duration, fortnightly), access to online education modules, written manuals, coaching and mentoring, audit and feedback each fortnight of recommendation adherence, access to physical resources and environmental alterations to encourage patient independent practice. Group B, the self-directed implementation package group received: point of care videos, online education modules, posters of clinical practice guideline recommendations, written manuals, access to physical resources (e.g. electrical stimulation machines), care pathways to simplify clinical reasoning and consumer information (i.e. handouts for patients). Face to face education sessions (of 45mins in duration) were held every fortnight, each covering one of the six specified topic areas [Group A only]. Six online modules were made available every fortnight, each covering these same specified topic areas (written version of the content covered in face to face sessions). The duration of the online module content ranged from 15-20mins each, depending on topic area for that fortnight [Groups A and B]. All of the face-to-face education sessions and online modules were created specifically for this study by the research team, as were the written manuals (i.e. modified constraint induced movement therapy and electrical stimulation manuals). The videos were a combination of created videos, as well as videos available from YouTube (https://www.youtube.com/watch?v=Ze9j-IeTy8Q; https://www.youtube.com/watch?v=i_HbuynsRV8) Throughout the study period, clinicians in Group A received specific coaching during the face to face sessions (approximately 10-15 minutes of the 45min session) by a researcher (and expert in upper limb rehabilitation) which included demonstration and problem solving some of the challenges therapists raised during the session. Outside of this, Group A had access to researchers (upper limb experts) for one on one mentoring sessions and/or joint therapy sessions with patients, scheduled at the request of the clinician [Group A only]. Physical resources were provided to clinicians in Groups A and B, although they requested different resources. Group A: Physical resources provided included 1) electrical stimulation machines 2) constrain induced movement therapy mitts 3) a trolley of dedicated upper limb therapy equipment (i.e. items for gross and fine motor retraining such as balls, coins, cups, jars and utensils) 4) patient handouts detailing exercises 5) posters outlining safe positioning for the upper limb to be displayed in patient’s room 6) Graded Repetitive Arm Supplementary Program (GRASP) kits 7) Upper limb assessments including the Fugl-Meyer. The environmental alterations included: 1) dedicated ward space for patients to completing upper limb rehabilitation and independent practice 2) community therapists received a ‘mobile upper limb kit’ to take to patient’s home’s 3) a trolley full of items for upper limb therapy was provided in the dedicated ward space 4) storage space in the ‘equipment store rooms’ was allocated and re-stocked with upper limb equipment and assessments. Group B received: 1) electrical stimulation machines 2) patient handouts detailing exercises 3) Graded Repetitive Arm Supplementary Program (GRASP) kits 4) Upper limb assessments including the Fugl-Meyer At the conclusion of the study, participants were asked to self-report the use of implementation strategies provided. Method of allocation: Non-randomised; the six participating sites were pragmatically allocated into one of the three clusters (Group A, B and C).