Advertisement

Minimal Clinically Important Differences in Functional Independence After a Knowledge Translation Intervention in Stroke Rehabilitation

Published:November 15, 2019DOI:https://doi.org/10.1016/j.apmr.2019.10.185

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Polatajko H.
        • Mandich A.
        Enabling occupation in children: the cognitive orientation to daily occupational performance (CO-OP) approach.
        1st ed. CAOT Publications ACE, Ottawa, ON2004
        • McEwen S.
        • Polatajko H.
        • Baum C.
        • et al.
        Combined cognitive-strategy and task-specific training improve transfer to untrained activities in subacute stroke: an exploratory randomized controlled trial.
        Neurorehabil Neural Repair. 2015; 29: 526-536
        • Skidmore E.R.
        • Dawson D.R.
        • Butters M.A.
        • et al.
        Strategy training shows promise for addressing disability in the first 6 months after stroke.
        Neurorehabil Neural Repair. 2015; 29: 668-676
        • Ahn S.N.
        • Yoo E.Y.
        • Jung M.Y.
        • Park H.Y.
        • Lee J.Y.
        • Choi Y.I.
        Comparison of cognitive orientation to daily occupational performance and conventional occupational therapy on occupational performance in individuals with stroke: a randomized controlled trial.
        NeuroRehabilitation. 2017; 40: 285-292
        • Hebert D.
        • Lindsay M.P.
        • McIntyre A.
        • et al.
        Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015.
        Int J Stroke. 2016; 11: 459-484
        • Skidmore E.R.
        • McEwen S.E.
        • Green D.
        • van den Houten J.
        • Dawson D.
        • Polatajko H.J.
        Essential elements and key features of the CO–OP Approach.
        in: Dawson D.R. McEwen S.E. Polatajko H.J. Cognitive orientation to daily occupational performance in occupational therapy: using the CO-OP approach to enable participation across the lifespan. 1st ed. AOTA Press, Bethesda, MD2017: 11
        • McEwen S.E.
        • Poulin V.
        • Skidmore E.R.
        • Wolf T.J.
        Using the CO–OP approach: stroke.
        in: Dawson D.R. McEwen S.E. Polatajko H.J. Cognitive Orientation to daily Occupational Performance in occupational therapy: the CO-OP approach to enable participation across the lifespan. 1st ed. AOTA Press, Bethesda, MD2017: 93-117
        • McEwen S.E.
        • Donald M.
        • Dawson D.
        • et al.
        A multi-faceted knowledge translation approach to support persons with stroke and cognitive impairment: evaluation protocol.
        Implement Sci. 2015; 10: 157
        • Graham I.D.
        • Logan J.
        • Harrison M.B.
        • et al.
        Lost in knowledge translation: time for a map?.
        J Contin Educ Health Prof. 2006; 26: 13-24
        • McEwen S.E.
        • Donald M.
        • Jutzi K.
        • et al.
        Implementing a function-based cognitive strategy intervention within inter-professional stroke rehabilitation teams: changes in provider knowledge, self-efficacy and practice.
        PLoS One. 2019; 14e0212988
      1. Uniform Data Set for Medical Rehabilitation. The FIM(R) Instrument: Its background, structure, and usefulness.
        UDSMR, Buffalo2012
        • Beninato M.
        • Gill-Body K.M.
        • Salles S.
        • Stark P.C.
        • Black-Schaffer R.M.
        • Stein J.
        Determination of the minimal clinically important difference in the FIM instrument in patients with stroke.
        Arch Phys Med Rehabil. 2006; 87: 32-39
        • Canadian Institutes of Health Research
        Knowledge translation – definition.
        (Available at:)
        • Lynch E.A.
        • Chesworth B.M.
        • Connell L.A.
        Implementation—the missing link in the research translation pipeline: is it any wonder no one ever implements evidence-based practice?.
        Neurorehabil Neural Repair. 2018; 32: 751-761