Abstract
Objective
To examine the odds of persons with stroke achieving minimal clinically important
difference (MCID) in functional independence during inpatient rehabilitation relative
to cognitive impairment (CI) severity, site, and rehabilitation teams’ exposure to
a Cognitive Orientation to daily Occupational Performance (CO-OP) knowledge translation
(KT) intervention.
Design
A pre-post observational study was conducted using data from a centralized referral
system. Our research team implemented a CO-OP KT intervention as part of a larger
study aimed at training teams to use the CO-OP approach.
Setting
Five inpatient rehabilitation units.
Participants
Cases extracted from a centralized referral system from the 5 participating units.
Interventions
Not applicable.
Main Outcome Measures
The FIM instrument data from 12 months preintervention and 6 months postintervention
were analyzed. A logistic regression was performed to determine the odds ratios (ORs)
for achieving MCID based on sample cohort (historical control not exposed to CO-OP
KT vs post-CO-OP KT intervention), controlling for site and severity of CI.
Results
A model that considered the intervention, admission score, CI severity, and site was
the best fit for the cases analyzed. Those with severe CI were less likely to achieve
FIM total MCID compared to those with no CI (P=<.001; OR=.18; 95% confidence interval, .09-.39). Taking site and CI into account,
cases post CO-OP KT intervention were significantly more likely to achieve MCID on
FIM motor (P=.048; OR=1.4; 95% confidence interval, 1.00-1.98) than historical controls.
Conclusion
The CO-OP KT intervention is associated with increased odds of achieving MCID in the
FIM motor subscale in inpatient stroke rehabilitation.
Keywords
List of abbreviations:
CI (cognitive impairment), CO-OP (Cognitive Orientation to daily Occupational Performance), E-stroke (E-Stroke Rehabilitation Referral System), KT (knowledge translation), MCID (minimal clinically important difference), OR (odds ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 15, 2019
Footnotes
Supported by the Canadian Institutes of Health Research, Partnerships for Health System Improvement (grant no. PHE-141799).
Clinical Trial Registration No.: NCT02597569.
Lisa Avery reports personal fees from Avery Information Services Ltd. during the conduct of the study. The other authors have nothing to disclose.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
