title: Combined clinical and home rehabilitation: case report of an integrated knowledge-to-action study in a Dutch rehabilitation stroke unit.
abstract: OBJECTIVE
  There is growing awareness that the poor uptake of evidence in health care is not a knowledge-transfer problem but rather one of knowledge production. This issue calls for re-examination of the evidence produced and assumptions that underpin existing knowledge-to-action (KTA) activities. Accordingly, it has been advocated that KTA studies should treat research knowledge and local practical knowledge with analytical impartiality. The purpose of this case report is to illustrate the complexities in an evidence-informed improvement process of organized stroke care in a local rehabilitation setting.
  
  
  METHODS
  A participatory action approach was used to co-create knowledge and engage local therapists in a 2-way knowledge translation and multidirectional learning process. Evidence regarding rehabilitation stroke units was applied in a straightforward manner, as the setting met the criteria articulated in stroke unit reviews. Evidence on early supported discharge (ESD) could not be directly applied because of differences in target group and implementation environment between the local and reviewed settings. Early supported discharge was tailored to the needs of patients severely affected by stroke admitted to the local rehabilitation stroke unit by combining clinical and home rehabilitation (CCHR).
  
  
  RESULTS
  Local therapists welcomed CCHR because it helped them make their task-specific training truly context specific. Key barriers to implementation were travel time, logistical problems, partitioning walls between financing streams, and legislative procedures.
  
  
  CONCLUSIONS
  Improving local settings with available evidence is not a straightforward application process but rather a matter of searching, logical reasoning, and creatively working with heterogeneous knowledge sources in partnership with different stakeholders. Multiple organizational levels need to be addressed rather than focusing on therapists as sole site of change.
authors.affiliation: C.S. Nanninga, PT, MSc, University Medical Center Groningen, Center for Rehabilitation, University of Groningen, Dilgtweg 5, 9751 ND Haren, the Netherlands. c.s.nanninga@umcg.nl.
authors.forename: Christa S
authors.initials: CS
authors.lastname: Nanninga
authors.affiliation: K. Postema, MD, PhD, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen.
authors.forename: Klaas
authors.initials: K
authors.lastname: Postema
authors.affiliation: M.C. Schönherr, MD, PhD, University Medical Center Groningen, Center for Rehabilitation, University of Groningen.
authors.forename: Marleen C
authors.initials: MC
authors.lastname: Schönherr
authors.affiliation: S. van Twillert, PT, MSc, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen.
authors.forename: Sacha
authors.initials: S
authors.lastname: van Twillert
authors.affiliation: A.T. Lettinga, PT, PhD, University Medical Center Groningen, Center for Rehabilitation, University of Groningen.
authors.forename: Ant T
authors.initials: AT
authors.lastname: Lettinga
mesh_terms: D055812:Community-Based Participatory Research; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration; D006801:Humans; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D012046:Rehabilitation / Q000458:organization & administration*; D012047:Rehabilitation Centers / Q000458:organization & administration; D000071939:Stroke Rehabilitation; D057170:Translational Research, Biomedical