title: A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation.
abstract: Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills.
  
  
  
  A multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study.
  
  
  
  Eleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19thpercentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported that client motivation to engage with VR facilitated IREX use in practice but that environmental and IREX-specific barriers limited use.
  
  
  
  Despite increased knowledge and skills in VR use, the KT intervention did not alter the number of perceived barriers to VR use, intention to use or actual use of VR. Poor perceived system usability had an impact on integration of this particular VR system into clinical practice.
authors.affiliation: Department of Physical Therapy, Movement Sciences and Rehabilitation, Bouve College of Health Sciences, Northeastern University, 407c Robinson Hall, 360 Huntington Ave, Boston, MA, 02115, USA. d.levac@northeastern.edu.
authors.forename: Danielle
authors.initials: D
authors.lastname: Levac
authors.affiliation: Therapy Department, Sunny Hill Health Centre for Children, 3644 Slocan Street, Vancouver, BC, V5M 3E8, Canada.
authors.forename: Stephanie M N
authors.initials: SM
authors.lastname: Glegg
authors.affiliation: School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 200 Lees (A121), Ottawa, ON, K1S 5S9, Canada.
authors.forename: Heidi
authors.initials: H
authors.lastname: Sveistrup
authors.affiliation: Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave Toronto, Ontario, M5G 1V7, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Colquhoun
authors.affiliation: School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. West, Hamilton, ON, L8S 1C7, Canada.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Miller
authors.affiliation: Bruyere Research Institute, Élisabeth Bruyère Hospital, Bruyère Continuing Care, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada.
authors.forename: Hillel
authors.initials: H
authors.lastname: Finestone
authors.affiliation: School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, ON, K7L 3 N6, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: DePaul
authors.affiliation: School of Rehabilitation Science, McMaster University, IAHS Building Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
authors.forename: Jocelyn E
authors.initials: JE
authors.lastname: Harris
authors.affiliation: Hamilton Health Sciences, Regional Rehabilitation Centre, 300 Wellington St. North, Hamilton, ON, Canada.|Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster Univerity, 12 Main Street West, Hamilton, ON, l8S 1C7, Canada.
authors.forename: Diana
authors.initials: D
authors.lastname: Velikonja
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards; D003198:Computer Simulation; D005081:Exercise Therapy / Q000379:methods / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020377:Self Efficacy; D000071939:Stroke Rehabilitation / Q000379:methods* / Q000592:standards; D057170:Translational Research, Biomedical; D014584:User-Computer Interface
keywords: Knowledge translation; Rehabilitation; Stroke; Virtual reality