A formative evaluation of the implementation of an upper limb stroke rehabilitation intervention in clinical practice: a qualitative interview study.
A formative evaluation of the implementation of an upper limb stroke rehabilitation intervention in clinical practice: a qualitative interview study.
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DOI：
10.1186/s13012-014-0090-3
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发表时间：
2014-08-12
期刊：
影响因子：
--
通讯作者：
Eng JJ
中科院分区：
文献类型：
--
作者：
Connell LA;McMahon NE;Harris JE;Watkins CL;Eng JJ
分级重复性手臂补充计划（GRASP）是一种手部和手臂锻炼计划，旨在增加住院中风康复患者的锻炼强度。在2009年的一项随机对照试验中，GRASP被证明是有效的，并且此后经历了异常迅速的临床实践。本研究的目的是对GRASP的实施进行形成性评估，为英国类似干预措施的制定和实施提供信息。对参与在工作场所实施GRASP的治疗师或有使用GRASP经验的治疗师进行半结构化访谈。正常化过程理论（NPT）是一种社会学理论，用于探索在实践中嵌入创新的过程，并用于制定采访指南。在GRASP指南手册中概述的干预成分被用来开发提示，以探索治疗师如何在实践中使用GRASP。访谈记录采用基于实施理论的编码框架进行分析。在加拿大不列颠哥伦比亚省的八个地点进行了20次访谈。治疗师确定非正式网络和免费在线获取的GRASP是了解干预措施的关键因素。所有治疗师都报告了对GRASP价值的积极看法。在所有地点，治疗师都确定了主张使用GRASP的个人，在8个地点中的6个是实践领导者或高级治疗师。康复助理被认为是在几乎所有地点提供GRASP的工具，因为他们负责组织GRASP设备并协助患者使用GRASP。在临床实践中，几乎所有的干预成分都有一定程度的适应性；覆盖范围更广，内容更合适，而在监测时，剂量更少。尽管GRASP已经转化为临床实践，但它并不总是以被证明有效的方式使用。这种形成性的评估告知了一种新的干预措施的发展，旨在弥合中风后上肢康复的证据与实践之间的差距。本文的在线版本（doi:10.1186/s13012-014-0090-3）包含补充资料，仅供授权用户使用。
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. 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. 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. 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. The online version of this article (doi:10.1186/s13012-014-0090-3) contains supplementary material, which is available to authorized users.
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影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
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