Table 2 Outcomes, indicators, and timing for all studies
Outcomes | Indicators and description | Timing |
|---|---|---|
Study 1: health system: data obtained from electronic referral system, health record, and NRS | ||
Access to inpatient rehabilitation | Monthly totals: # of inpatient rehab referrals, # of admissions, # declined; reasons for declined referrals | • −T28 to −T1 • T1 to T15 |
Inpatient rehab outcomes | Average monthly functional independence measure (FIM™) motor and cognitive scores (admission, discharge, and change) | • −T28 to −T1 • T1 to T15 |
Monthly frequency of discharge locations (home, home with services, assisted living facility, or acute care) | ||
Study 2: health knowledge: data obtained from stroke rehabilitation team members and chart audits | ||
Rehabilitation team member practice change | Chart audits will be conducted 6 months (+/−1 month) before CO-OP KT implementation as a baseline and to confirm practice gaps previously identified with interviews [4], and repeated at 6 and 12 months (+/−1 month) following the CO-OP KT intervention. The chart audit review criteria will center around documentation of functional goals (e.g., independence with upper body dressing), rather than impairment-reduction goals (e.g., increase arm strength); evidence of patient involvement in the goal-setting process; evidence of teaching of cognitive and problem-solving strategies as an intervention technique; evidence of use of guided discovery as an intervention technique | • −T6 • T6, T12 |
Stroke rehab professional self-efficacy with knowledge and skills related to CO-OP | CO-OP essential elements self-efficacy tool: participants are asked to rate their ability to perform 25 elements on a 10-point scale, with 1 indicating that they cannot perform the element at all and 10 indicating that their performance is excellent. Face validity evaluated by five members of the International CO-OP Academy | • −T1 • T1 • T12 |
Team perceptions and experiences with team processes, practices, attitudes related to adoption and sustainability of best practices for cognitive rehabilitation | Semi-structured site-specific focus group with groups of 5–8 team members at a time. Focus groups will be conducted by experienced facilitator Dr. Anne Hunt who will begin with an open-ended question “What has been your experience with facilitating recovery in patients with cognitive impairment?” Based on responses, Dr. Hunt will probe to obtain a thorough understanding of perceptions and experiences from a wide range of team members at each site | • −T1 • T12 |
Study 3: health outcomes: data obtained from consenting individual patients | ||
Performance on personally-meaningful, self-selected activities | The Canadian occupational performance measure (COPM) is a standardized instrument for eliciting performance issues from the client perspective, and for capturing perceived changes in performance over time [16]. The COPM has demonstrated test-retest reliability of 0.89 in people with stroke [34]. A change of 2 points or more on the COPM is considered clinically significant [16] | • Admission to inpatient rehabilitation • Discharge from inpatient rehabilitation • 1 month post discharge • 3 months post discharge • 6 months post discharge |
Self-efficacy to perform daily activities | The self-efficacy gauge (SEG) was designed to measure an individual’s self-efficacy in his or her ability to perform daily occupations that span a range of self-care, productivity, and leisure activities. Participants are asked to rate their confidence in their ability to perform 28 items, each on a 10-point scale, with 1 representing “not confident at all” and 10 representing “completely confident”. The SEG has very high internal consistency (0.94) and test-retest reliability (0.90) [35] | |
Health status | The stroke impact scale (SIS) [36] is a 59-item questionnaire about the perceived impact of stroke on function and everyday life. The SIS evaluates eight domains. Each item is scored on a 5-point Likert scale related to the degree of difficulty the person with stroke is experiencing. The SIS is widely used in stroke intervention studies as an outcome measure and the psychometric properties of the instrument are well defined [36–38] | |
Cognitive screening tool | The MoCA is a 30-item test of cognitive impairment that includes elements of short-term memory recall; visuospatial capacity; aspects of executive functioning; attention, concentration, and working memory; language; and orientation [29]. The MoCA has excellent internal consistency (0.83) and test-retest reliability (0.92) [29] | |