Implementation interventions to promote the uptake of evidence-based practices in stroke rehabilitation

• Published in: Cochrane database of systematic reviews 2020-10, Vol.10 (10), p.CD012575-CD012575
• Main Authors: Cahill, Liana S, Carey, Leeanne M, Lannin, Natasha A, Turville, Megan, Neilson, Cheryl L, Lynch, Elizabeth A, McKinstry, Carol E, Han, Jia Xi, O'Connor, Denise
• Format: Article
• Language: English
• Subjects: Effective practice & health systems; Evidence-Based Medicine - education; Evidence-Based Medicine - methods; Evidence-Based Medicine - statistics & numerical data; Health Personnel - education; Health Personnel - statistics & numerical data; Health Status; Heart & circulation; Humans; Implementation strategies; Insurance medicine; Patient Compliance - statistics & numerical data; Randomized Controlled Trials as Topic; Stroke Rehabilitation - methods; Stroke Rehabilitation - psychology
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD012575.pub2

Rehabilitation based upon research evidence gives stroke survivors the best chance of recovery. There is substantial research to guide practice in stroke rehabilitation, yet uptake of evidence by healthcare professionals is typically slow and patients often do not receive evidence-based care. Implementation interventions are an important means to translate knowledge from research to practice and thus optimise the care and outcomes for stroke survivors. A synthesis of research evidence is required to guide the selection and use of implementation interventions in stroke rehabilitation. To assess the effects of implementation interventions to promote the uptake of evidence-based practices (including clinical assessments and treatments recommended in evidence-based guidelines) in stroke rehabilitation and to assess the effects of implementation interventions tailored to address identified barriers to change compared to non-tailored interventions in stroke rehabilitation. We searched CENTRAL, MEDLINE, Embase, and eight other databases to 17 October 2019. We searched OpenGrey, performed citation tracking and reference checking for included studies and contacted authors of included studies to obtain further information and identify potentially relevant studies. We included individual and cluster randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies comparing an implementation intervention to no intervention or to another implementation approach in stroke rehabilitation. Participants were qualified healthcare professionals working in stroke rehabilitation and the patients they cared for. Studies were considered for inclusion regardless of date, language or publication status. Main outcomes were healthcare professional adherence to recommended treatment, patient adherence to recommended treatment, patient health status and well-being, healthcare professional intention and satisfaction, resource use outcomes and adverse effects. Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. The primary comparison was any implementation intervention compared to no intervention. Nine cluster randomised trials (12,428 patient participants) and three ongoing trials met our selection criteria. Five trials (8865 participants) compared an implementation intervention to no intervention, three trials (3150 participants) compared one imple