title: Development and Evaluation of Self-Management and Task-Oriented Approach to Rehabilitation Training (START) in the Home: Case Report.
abstract: BACKGROUND
  The incidence of stroke and subsequent level of disability will increase, as age is the greatest risk factor for stroke and the world's population is aging. Hospital admissions are too brief for patients to regain necessary function. Research to examine therapy delivered within the home environment has the potential to expedite relearning of function and reduce health care expenditures.
  
  
  OBJECTIVE
  This case report describes the use of the knowledge-to-action cycle (KTA) to develop and evaluate an evidence-based approach for rehabilitation in the home that incorporates self-management and task-oriented functional training (TOFT) for people with stroke.
  
  
  METHODS
  The KTA cycle was used to guide adaptation of evidence from self-management and TOFT into an approach titled START (Self-Management and Task-Oriented Approach to Rehabilitation Training). Three stakeholder symposiums identified barriers and supports to implementation. Clinical practice leaders were engaged as partners in the development of the intervention. An online learning management system housed the resources to support therapist training. Therapist focus groups were conducted and stroke outcomes were used to assess patient response.
  
  
  RESULTS
  Eight therapists completed 4 workshops and applied the home intervention in 12 people with stroke. A mentoring process for therapists included feedback from peers and experts after viewing treatment videos. Therapist response was determined from the focus groups; patient response was measured by standardized assessments. The therapists noted that the intervention was easier to implement with patients who were motivated and had minimal cognitive impairment.
  
  
  CONCLUSIONS
  The KTA cycle provided a structure for the development of this evidence-based rehabilitation intervention, which was feasible to implement in the home. Further evaluation needs to be undertaken to assess the effectiveness of START.
authors.affiliation: J. Richardson, PhD, School of Rehabilitation Science, Faculty of Health Science, McMaster University, IAHS Room 403, 1400 Main St W, Hamilton, Ontario, Canada L8S 1C7. jrichard@mcmaster.ca.
authors.forename: Julie
authors.initials: J
authors.lastname: Richardson
authors.affiliation: V. DePaul, PhD, School of Rehabilitation Science, Faculty of Health Science, McMaster University, and Department of Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. Dr DePaul's primary affiliation is currently the Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: DePaul
authors.affiliation: A. Officer, MScPT, School of Rehabilitation Science, Faculty of Health Science, McMaster University.
authors.forename: Alexis
authors.initials: A
authors.lastname: Officer
authors.affiliation: S. Wilkins, PhD, School of Rehabilitation Science, Faculty of Health Science, McMaster University.
authors.forename: Seanne
authors.initials: S
authors.lastname: Wilkins
authors.affiliation: L. Letts, PhD, School of Rehabilitation Science, Faculty of Health Science, McMaster University.
authors.forename: Lori
authors.initials: L
authors.lastname: Letts
authors.affiliation: J. Bosch, PhD, School of Rehabilitation Science, Faculty of Health Science, McMaster University.
authors.forename: Jackie
authors.initials: J
authors.lastname: Bosch
authors.affiliation: L. Wishart, PhD, School of Rehabilitation Science, Faculty of Health Science, McMaster University.
authors.forename: Laurie
authors.initials: L
authors.lastname: Wishart
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D019317:Evidence-Based Medicine; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services; D006792:House Calls; D006801:Humans; D008297:Male; D008611:Mentors; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D010347:Patient Care Planning; D026741:Physical Therapy Modalities / Q000193:education; D012648:Self Care; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D055815:Young Adult