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Table 3 Factors influencing the implementation and use of GRASP

From: A formative evaluation of the implementation of an upper limb stroke rehabilitation intervention in clinical practice: a qualitative interview study

Inner and outer setting
Access to knowledge and information Ten therapists reported that the GRASP website and free online availability of the treatment protocol enabled them to find out about the intervention and also facilitated its continued use.
Cosmopolitanism Therapists reported finding out about GRASP through existing networks with the research team at GF Strong (where GRASP was developed) and national meetings with 11 therapists mentioning Janice Eng by name.
Leadership engagement The implementation of GRASP was facilitated by active engagement of practice leaders and clinical supervisors as they were responsible both for identifying the programme and introducing it at the work site by acquiring resources to support implementation e.g., funding for equipment.
Intervention characteristics
Design, quality and packaging GRASP was perceived to be well designed and presented. The large text and clear pictures were seen to be highly beneficial, particularly for a population often suffering from some degree of cognitive impairment. Therapists reported that the manual could be improved by shortening it and reducing repetition of exercises within and between levels of manuals.
Evidence strength and quality All therapists agreed that GRASP was underpinned by best evidence for motor recovery after stroke and reported sharing this information with the patients to whom they prescribed GRASP.
Relative advantage The primary advantage of GRASP was that it provided a more time efficient way of providing exercises to patients – something that therapists regularly do in practice anyway.
Complexity Organising the GRASP equipment was identified as the most complex component of the intervention and this influenced the way in which the intervention was used i.e., substituting items of equipment or omitting some exercises altogether.
Characteristics of individuals
Knowledge and beliefs Therapists’ beliefs about the quality of exercises that patients would be able to complete outside of therapy time influenced the way in which GRASP was used in practice e.g., completing GRASP exercises during therapy time.