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  • Evidence-based practice ‘on-the-go’: using ViaTherapy as a tool to enhance clinical decision making in upper limb rehabilitation after stroke, a quality improvement initiative

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Quality Improvement Report
Evidence-based practice ‘on-the-go’: using ViaTherapy as a tool to enhance clinical decision making in upper limb rehabilitation after stroke, a quality improvement initiative
  1. Nicola J Hancock1,
  2. Kathryn Collins2,
  3. Charlie Dorer3,
  4. Steven L Wolf4,
  5. Mark Bayley5,6,
  6. Valerie M Pomeroy1
  1. 1Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, UK
  2. 2Faculty of Health and Social Sciences, Department of Human Sciences and Public Health, Bournemouth University, Bournemouth, United Kingdom
  3. 3Integrated Neuro Rehabilitation and Stroke ESD Team, Cambridge and Peterborough Foundation Trust, Cambridge, UK
  4. 4Division of Physical Therapy, School of Medicine, Emory University, Atlanta, Georgia, USA
  5. 5Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  6. 6University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
  1. Correspondence to Dr Nicola J Hancock, University of East Anglia School of Health Sciences, Norwich, UK; n.hancock{at}uea.ac.uk

Abstract

Recovery of upper limb function after stroke is currently sub-optimal, despite good quality evidence showing that interventions enabling repetitive practice of task-specific activity are effective in improving function. Therapists need to access and engage with such evidence to optimise outcomes with people with stroke, but this is challenging in fast-paced stroke rehabilitation services. This quality improvement project aimed to investigate acceptability and service impact of a new, international tool for accessing evidence on upper limb rehabilitation after stroke—‘ViaTherapy’—in a team of community rehabilitation therapists. Semi-structured interviews were undertaken at baseline to determine confidence in, and barriers to, evidence-based practice (EBP) to support clinical decision making. Reported barriers included time, lack of access to evidence and a research-practice disconnect. The clinicians then integrated use of ‘ViaTherapy’ into their practice for 4 weeks. Follow-up interviews explored the accessibility of the tool in community rehabilitation practice, and its impact on clinician confidence, treatment planning and provision. Clinicians found the tool, used predominantly in mobile device app format, to be concise and simple to use, providing evidence ‘on-the-go’. Confidence in accessing and using EBP grew by 22% from baseline. Clinicans reported changes in intensity of delivery of interventions, as rapid access to recommended doses via the tool was available. Following this work, the participating health and social care service provider changed provision of therapists’ technology to enable use of apps. Barriers to use of EBP in stroke rehabilitation persist; the baseline situation here supported the need for more accessible means of integrating best evidence into clinical processes. This quality improvement project successfully integrated ViaTherapy into clinical practice, and found that the tool has potential to underpin positive changes in upper limb therapy service delivery after stroke, by increasing accessibility to, use of and confidence in EBP. Definitive evaluation is now indicated.

  • quality improvement
  • clinical practice guidelines

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2018-000592

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    Footnotes

    • Contributors NH was the academic lead for the QI project, involved in its conception, design, analysis and interpretation of data, and drafting and revising the manuscript. KC was the QI team member involved in project design, data acquisition and interpretation, and drafting and revising the manuscript. CD was the NHS lead for the QI project and gatekeeper to the clinical team, involved in the conception and design of the work and important revisions to the manuscript. SW and MB made substantial contribution to the conception of the work and made critical academic contribution to the manuscript. VMP was the QI project supervisor, involved in conception and design of the project, overseeing acquisition and interpretation of data and critically revising the manuscript for important content.

    • Funding This project was funded by the University of East Anglia Impact Funding (HEIF). Initial support for the development of the ViaTherapy app came from the Canadian Stroke Network.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.