title: A multi-faceted knowledge translation approach to support persons with stroke and cognitive impairment: evaluation protocol.
abstract: BACKGROUND
  Patients with cognitive impairments following a stroke are often denied access to inpatient rehabilitation. The few patients with cognitive impairment admitted to rehabilitation generally receive services based on outdated impairment-reduction models, rather than recommended function-based approaches. Both reduced access to rehabilitation and the knowledge-to-practice gap stem from a reported lack of skills and knowledge regarding cognitive rehabilitation on the part of inpatient rehabilitation team members. To address these issues, a multi-faceted knowledge translation (KT) initiative will be implemented and evaluated. It will be targeted specifically at the inter-professional application of the cognitive orientation to daily occupational performance (CO-OP). CO-OP training combined with KT support is called CO-OP KT. The long-term objective of CO-OP KT is to optimize functional outcomes for individuals with stroke and cognitive impairments. Three research questions are posed: 1. Is the implementation of CO-OP KT associated with a change in the proportion of patients with cognitive impairment following a stroke accepted to inpatient rehabilitation? 2. Is the implementation of CO-OP KT associated with a change in rehabilitation clinicians' practice, knowledge, and self-efficacy related to implementing the CO-OP approach, immediately following and 1 year later? 3. Is CO-OP KT associated with changes in activity, participation, and self-efficacy to perform daily activities in patients with cognitive impairment following stroke at discharge from inpatient rehabilitation and at 1-, 3-, and 6-month follow-ups?
  
  
  METHODS
  Three interrelated studies will be conducted. Study 1 will be a quasi-experimental, interrupted time series design measuring monthly summaries of stroke unit level data. Study 2, which relates to changes in health care professional practice and self-efficacy, will be a single group pre-post evaluation design incorporating chart audits and a self-report survey. Study 3 will assess patient functional outcomes using a non-randomized design with historical controls. Assessments will occur during admission and discharge from rehabilitation and at 1, 3, and 6 months following discharge from rehabilitation.
  
  
  CONCLUSIONS
  This project will advance knowledge about the degree to which the implementation of a supported KT initiative can sustainably change health system, knowledge, and patient outcomes.
authors.affiliation: Sunnybrook Research Institute, Toronto, Canada. sara.mcewen@utoronto.ca.|University of Toronto, Toronto, Canada. sara.mcewen@utoronto.ca.
authors.forename: Sara E
authors.initials: SE
authors.lastname: McEwen
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Donald
authors.affiliation: University of Toronto, Toronto, Canada.|Rotman Research Institute, Baycrest, Toronto, Canada.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Dawson
authors.affiliation: University of Ottawa, Ottawa, Canada.
authors.forename: Mary Y
authors.initials: MY
authors.lastname: Egan
authors.affiliation: Bloorview Research Institute and Holland Bloorview Kids Rehab Hospital, Toronto, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Hunt
authors.affiliation: University of Toronto, Toronto, Canada.|Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Quant
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Sharron
authors.initials: S
authors.lastname: Runions
authors.affiliation: University of Toronto, Toronto, Canada.|Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Linkewich
mesh_terms: D000203:Activities of Daily Living; D003072:Cognition Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D007857:Leadership; D009788:Occupational Therapy / Q000379:methods*; D015397:Program Evaluation; D012107:Research Design; D020377:Self Efficacy; D058992:Social Participation; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D057170:Translational Research, Biomedical / Q000379:methods*