Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
The study objective was to examine the implementation barriers and facilitators after a year of training and use of a task-specific training manual in inpatient rehabilitation. The Consolidated Framework for Implementation Research provided structure for the survey of OTs. Stakeholders reported confidence in evidence incorporation, and the barriers related to ease of selection and use of this intervention need to be addressed.
Primary Author and Speaker: Eron Bozec
Additional Authors and Speakers: Namrata Grampurohit
Contributing Authors: Namrata Grampurohit, Jaime Gorska
PURPOSE: Translating knowledge from research to clinical practice is challenging throughout healthcare (Upton et al., 2014) and strategies to identify and overcome barriers are needed (Juckett et al., 2020). The Consolidated Framework for Implementation Research (CFIR) provides a framework to identify implementation barriers and facilitators within the domains: 1) intervention characteristics, 2) outer setting, 3) inner setting, 4) characteristics of individuals, and 5) process (Damschroder et al., 2009). Barrier identification is important prior to developing robust implementation strategies (Juckett et al., 2020). Bozec et al. (2020) developed an evidence-informed manual for inpatient rehabilitation to implement task-specific training—an intervention in occupational therapy (OT) for neurological conditions. The study objective was to examine the implementation barriers after a year of training and manual usage.
DESIGN: Cross-sectional survey of inpatient occupational therapists.
METHOD: Survey questions were developed for each CFIR domain and administered via email link. Survey was open for three weeks, and two reminders were sent. The survey contained 40 questions with four open-ended comment boxes. Stakeholders were all occupational therapists including assistants, clinical educators, and program directors. Descriptive statistics were used for quantitative analysis and content analysis of open-ended questions. The data was categorized as facilitators and barriers in each CFIR domain.
RESULTS: Nine of the 30 potential stakeholders (30%) completed the survey with eight staff therapists and one lead occupational therapist. Barriers related to intervention characteristics were access to materials and their cost, lack of confidence in task-specific training compared to other interventions, and difficulty integrating task-specific training during a therapy session. Outer setting barriers included knowledge that external organizations provide task-specific training and would be able to provide task-specific training. The lack of expectation to incorporate task-specific training was identified as the only inner setting barrier. Open-ended question analysis revealed additional barriers related to lack of quick intervention set up, access to materials, and lack of written step-by-step guidance. Facilitators identified included intervention characteristics such as confidence in the evidence and intervention flexibility. Inner setting facilitators included an appropriate workload, leadership engagement, and staff communication. Additional facilitators in the characteristics of individuals who reported adequate knowledge of the intervention technique and knowledge of the process to incorporate task-specific training.
CONCLUSION: The CFIR provided a framework to systematically examine the barriers and facilitators for implementation of an evidence-based task-specific training manual within inpatient rehabilitation. Although stakeholders stated they have confidence in the intervention evidence and are knowledgeable on the incorporation process, the gap in their ability to understand the benefits compared to other interventions and rationalize the intervention use needs to be addressed. After barrier identification, the next step is to plan for a comprehensive training program to promote evidence-based practice. Future research can also assess the impact on client and program outcomes in OT. The research impacts two important areas in OT. First is the rigorous study of implementation barriers for evidence-based practice within inpatient rehabilitation. Second is the facilitation of task-specific training within OT in inpatient rehabilitation.
References
Bozec, E., Grampurohit, N., Gorska, J. Manualization of task-specific training in neurological conditions for inpatient rehabilitation. Annual Conference of the American Occupational Therapy Association, 2020, Boston, MA.
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, 50. https://doi.org/10.1186/1748-5908-4-50
Juckett, L.A., Wengerd, L.R., Faieta, J., & Griffin, C. E. (2020). Evidence-based practice implementation in stroke rehabilitation: A scoping review of barriers and facilitators. American Journal of Occupational Therapy, 74, 7401205050. https://doi.org/10.5014/ajot.2020.035485
Upton, D., Stephens, D., Williams, B., & Scurlock-Evans, L. (2014). Occupational therapists' attitudes, knowledge, and implementation of evidence-based practice: A systematic review of published research. The British Journal of Occupational Therapy, 77(1), 24-38. https://doi.org/10.4276/030802214X13887685335544
