None listed
Conditions
Brief summary
The trial will test the clinical benefit and cost effectiveness of an implementation package to increase clinician use of arm and stroke rehabilitation evidence in practice. We hypothesise that providing support (education, mentorship) alongside resources (such as equipment and processes) will increase clinician use of the evidence. We will recruit 14 hospitals across 3 Australian states to deliver arm rehabilitation to 238 patients after stroke. The primary outcome is clinician adherence to guidelines, with secondary outcomes of patient arm and hand movement, health-related quality of life and cost. To understand the challenges faced during the PROMOTE trial, we will conduct a process evaluation alongside the main trial. Then, in partnership with the Stroke Foundation, we will employ implementation science methods to work with consumers and clinicians to develop an implementation strategy. Together these will allow rapid translation of findings into routine stroke care.
Interventions
The Promote experimental intervention aims to increase the therapy team’s delivery of recommended upper limb therapies to stroke inpatients, specifically task-specific motor training, mirror box therapy, electrical stimulation, constraint-induced movement therapy and/or mental imagery.
To increase delivery of these therapies, the Promote experimental intervention includes:
• Providing a copy of the NHMRC / Stroke Foundation ‘Clinical guidelines for stroke management’. These are available free on
The Promote experimental intervention aims to increase the therapy team’s delivery of recommended upper limb therapies to stroke inpatients, specifically task-specific motor training, mirror box therapy, electrical stimulation, constraint-induced movement therapy and/or mental imagery. To increase delivery of these therapies, the Promote experimental intervention includes: • Providing a copy of the NHMRC / Stroke Foundation ‘Clinical guidelines for stroke management’. These are available free online at https://informme.org.au/Guidelines • Online Education modules (specifically developed for this trial) which explain the NHMRC/Stroke Foundation clinical practice guideline recommendations. Total time to complete will depend on each individual clinician, but ranges between 30 minutes to 3 hours. • Specialist Education tailored to each site, provided as in-services, point-of-care demonstration videos, and written manuals to train clinicians in the skills related to the clinical guideline recommendations. This will augment (not replace) the online modules. Education provided by an experienced occupational therapist or physiotherapist with a minimum of 10y experience in stroke rehabilitation. The education will be delivered by a member of the core-research team, and supported locally at the site by a Guideline Champion. Education slides have been developed by the core research team to support the specialist education • Guideline Champion: an experienced clinician (Occupational Therapist or Physiotherapist with a minimum of 3 years in stroke rehabilitation) who advocates, encourages, coaches, mentors, educates, trains, persuades and motivates other clinicians. The Champion will be a clinician already employed at the Centre, who is provided with additional training at least 3 weeks prior to anticipated delivery of the Promote package. The Champion will support to mentor, coach and deliver the PROMOTE package. • Resources: electrical stimulation machines, GRASP kits, constraint-induced movement therapy mitts, treatment tables. Training in set-up and use of these resources will be provided by the core research team in the first weeks of delivery of the PROMOTE package. • Feedback from file-audits about current practice: medical records from a consecutive sample of the 5 most-recently discharged stroke patients from each centre team will be audited monthly. Feedback will address the number of people with stroke receiving recommended guidelines, the number of sessions per person, stroke severity, and team challenges. Audit-and-Feedback completed by the Guideline Champion (see above). Mode of delivery will be primarily face-to-face, but will include online meetings and education. Intervention is a mix of individually provided (such as the mentoring, joint-therapy sessions) and group (such as skills workshops and audit-and-feedback sessions; group size is anticipated to be approximately 10 clinicians however a maximum number will not be enforced). Wherever possible, these sessions will be provided by the Guideline Champion. All support and education will be logged during the trial. A six-month intervention period is delivered to each site. A minimum of 24 sessions are planned (education, skills, feedback) but total number of sessions delivered will be tailored to each site by their "Guideline Champion" who will work with their team to plan sessions. There are weekly education presentations (45min) and fortnightly audit-and-feedback sessions (30mins). Location of delivery is an inpatient rehabilitation hospital (clinician workplace).
Sponsors
Monash University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Centres will be Australian rehabilitation services who treat adults with stroke who present with upper limb impairments. All centres will receive >20 stroke referrals annually. Clinician participants will be occupational therapists, physiotherapists and/or allied health assistants who work at participating centres and deliver upper limb rehabilitation; Patient Participants will be aged 18 years or older, have sustained a stroke in the previous 6 months that has led to upper limb impairments. Be able to read and understand spoken English to a level where they can participate in the motor training program, and be eligible for upper limb rehabilitation as per the guidelines (i.e. have a minimum of 5-degree active wrist extension) and have a maximum ability to move 30 blocks on the Box and Block Test).
Exclusion criteria
Clinician participants who will not be working in the Centre for a minimum of 4 weeks of the PROMOTE period will be excluded. Patient participants who do not receive a minimum of 1 week of upper limb rehabilitation will be excluded.
Outcome results
None listed