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 accessOne-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 RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Enabling occupation in children: the cognitive orientation to daily occupational performance (CO-OP) approach.1st ed. CAOT Publications ACE, Ottawa, ON2004
- 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
- Strategy training shows promise for addressing disability in the first 6 months after stroke.Neurorehabil Neural Repair. 2015; 29: 668-676
- 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
- Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015.Int J Stroke. 2016; 11: 459-484
- 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
- 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
- A multi-faceted knowledge translation approach to support persons with stroke and cognitive impairment: evaluation protocol.Implement Sci. 2015; 10: 157
- Lost in knowledge translation: time for a map?.J Contin Educ Health Prof. 2006; 26: 13-24
- 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
- Uniform Data Set for Medical Rehabilitation. The FIM(R) Instrument: Its background, structure, and usefulness.UDSMR, Buffalo2012
- Determination of the minimal clinically important difference in the FIM instrument in patients with stroke.Arch Phys Med Rehabil. 2006; 87: 32-39
- Knowledge translation – definition.(Available at:)http://www.cihr-irsc.gc.ca/e/29418.html. LastDate accessed: March 14, 2019
- 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
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
