title: Case Series of a Knowledge Translation Intervention to Increase Upper Limb Exercise in Stroke Rehabilitation.
abstract: OBJECTIVE
  Current approaches to upper limb rehabilitation are not sufficient to drive neural reorganization and maximize recovery after stroke. To address this evidence-practice gap, a knowledge translation intervention using the Behaviour Change Wheel was developed. The intervention involves collaboratively working with stroke therapy teams to change their practice and increase therapy intensity by therapists prescribing supplementary self-directed arm exercise. The purposes of this case series are: (1) to provide an illustrative example of how a research-informed process changed clinical practice and (2) to report on staff members' and patients' perceptions of the utility of the developed intervention.
  
  
  METHODS
  A participatory action research approach was used in 3 stroke rehabilitation units in the United Kingdom. The intervention aimed to change 4 therapist-level behaviors: (1) screening patients for suitability for supplementary self-directed arm exercise, (2) provision of exercises, (3) involving family and caregivers in assisting with exercises, and (4) monitoring and progressing exercises. Data on changes in practice were collected by therapy teams using a bespoke audit tool. Utility of the intervention was explored in qualitative interviews with patients and staff.
  
  
  RESULTS
  Components of the intervention were successfully embedded in 2 of the 3 stroke units. At these sites, almost all admitted patients were screened for suitability for supplementary self-directed exercise. Exercises were provided to 77%, 70%, and 88% of suitable patients across the 3 sites. Involving family and caregivers and monitoring and progressing exercises were not performed consistently.
  
  
  CONCLUSIONS
  This case series is an example of how a rigorous research-informed knowledge translation process resulted in practice change. Research is needed to demonstrate that these changes can translate into increased intensity of upper limb exercise and affect patient outcomes.
authors.affiliation: L.A. Connell, PhD, College of Health and Wellbeing, University of Central Lancashire, Preston, PR1 2HE United Kingdom. laconnell@uclan.ac.uk.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Connell
authors.affiliation: N.E. McMahon, MA, College of Health and Wellbeing, University of Central Lancashire.
authors.forename: Naoimh E
authors.initials: NE
authors.lastname: McMahon
authors.affiliation: S.F. Tyson, PhD, Stroke and Vascular Research Centre, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom.
authors.forename: Sarah F
authors.initials: SF
authors.lastname: Tyson
authors.affiliation: C.L. Watkins, PhD, College of Health and Wellbeing, University of Central Lancashire.
authors.forename: Caroline L
authors.initials: CL
authors.lastname: Watkins
authors.affiliation: J.J. Eng, PhD, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Janice J
authors.initials: JJ
authors.lastname: Eng
mesh_terms: D001291:Attitude of Health Personnel; D017028:Caregivers; D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000379:methods*; D005190:Family; D006801:Humans; D010349:Patient Compliance; D017060:Patient Satisfaction; D018579:Patient Selection; D026761:Physical Therapy Specialty / Q000379:methods*; D012648:Self Care; D012944:Social Support; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation / Q000379:methods*; D057170:Translational Research, Biomedical; D034941:Upper Extremity / Q000503:physiopathology*