Development of a behaviour change intervention to increase upper limb exercise in stroke rehabilitation
Tóm tắt
Two thirds of survivors will achieve independent ambulation after a stroke, but less than half will recover upper limb function. There is strong evidence to support intensive repetitive task-oriented training for recovery after stroke. The number of repetitions needed is suggested to be in the order of hundreds, but this is not currently being achieved in clinical practice. In an effort to bridge this evidence-practice gap, we have developed a behaviour change intervention that aims to increase provision of upper limb repetitive task-oriented training in stroke rehabilitation. This paper aims to describe the systematic processes that took place in collaboratively developing the behaviour change intervention. The methods used in this study were not defined a priori but were guided by the Behaviour Change Wheel. The process was collaborative and iterative with four stages of development emerging (i) establishing an intervention development group; (ii) structured discussions to understand the problem, prioritise target behaviours and analyse target behaviours; (iii) collaborative design of theoretically underpinned intervention components and (iv) piloting and refining of intervention components. The intervention development group consisted of the research team and stroke therapy team at a local stroke rehabilitation unit. The group prioritised four target behaviours at the therapist level: (i) identifying suitable patients for exercises, (ii) provision of exercises, (iii) communicating exercises to family/visitors and (iv) monitoring and reviewing exercises. It also provides a method for self-monitoring performance in order to measure fidelity. The developed intervention, PRACTISE (Promoting Recovery of the Arm: Clinical Tools for Intensive Stroke Exercise), consists of team meetings and the PRACTISE Toolkit (screening tool and upper limb exercise plan, PRACTISE exercise pack and an audit tool). This paper provides an example of how the Behaviour Change Wheel may be applied in the collaborative development of a behaviour change intervention for health professionals. The process involved was resource-intensive, and the iterative process was difficult to capture. The use of a published behaviour change framework and taxonomy will assist replication in future research and clinical use. The feasibility and acceptability of PRACTISE is currently being explored in two other stroke rehabilitation units.
Tài liệu tham khảo
Nudo RJ. Recovery after brain injury: mechanisms and principles. Front Hum Neurosci. 2013;7:887.
Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, et al. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PloS One. 2014;9:e87987.
Kwah LK, Harvey LA, Diong J, Herbert RD. Models containing age and NIHSS predict recovery of ambulation and upper limb function six months after stroke: an observational study. J Physiother. 2013;59:189–97.
Nichols-Larsen DS, Clark PC, Zeringue A, Greenspan A, Blanton S. Factors influencing stroke survivors’ quality of life during subacute recovery. Stroke. 2005;36:1480–4.
Barker RN, Brauer SG. Upper limb recovery after stroke: the stroke survivors’ perspective. Disabil Rehabil. 2005;27:1213–23.
Lohse KR, Lang CE, Boyd LA. Is more better? Using metadata to explore dose–response relationships in stroke rehabilitation. Stroke. 2014;45:2053–8.
National Institute for Health and Care Excellence. Stroke Rehabilitation [CG162]. London: National Institute for Health and Care Excellence; 2013.
Nudo RJ, Wise BM, SiFuentes F, Milliken GW. Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct. Science. 1996;272:1791–4.
Kaur G, English C, Hillier S. How physically active are people with stroke in physiotherapy sessions aimed at improving motor function? A systematic review. Stroke Res Treat. 2012;2012:820673.
Lang C, MacDonald J, Reisman D, Boyd L, Kimberley T, Schindler-Ivens S, et al. Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil. 2009;90:1692–8.
Harris JE, Eng JJ, Miller WC, Dawson AS. A Self-Administered Graded Repetitive Arm Supplementary Program (GRASP) improves arm function during inpatient stroke rehabilitation a multi-site randomized controlled trial. Stroke. 2009;40:2123–8.
Connell LA, McMahon NE, Watkins CL, Eng JJ. Therapists’ use of the Graded Repetitive Arm Supplementary Program (GRASP) intervention: a practice implementation survey study. Phys Ther. 2014;94:632–43.
Connell L, McMahon N, Harris J, Watkins C, Eng J. A formative evaluation of the implementation of an upper limb stroke rehabilitation intervention in clinical practice: a qualitative interview study. Implement Sci 2014, 9.
Forster A, Young J, Nixon J, Kalra L, Smithard D, Patel A, et al. A cluster randomized controlled trial of a structured training programme for caregivers of inpatients after stroke (TRACS). Int J Stroke. 2012;7:94–9.
Forster A, Dickerson J, Melbourn A, Steadman J, Wittink M, Young J et al. The development and implementation of the structured training programme for caregivers of inpatients after stroke (TRACS) intervention: The London Stroke Carers Training Course. Clin Rehabil 2014; 0269215514543334.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655–5.
Corry M, Clarke M, While AE, Lalor J. Developing complex interventions for nursing: a critical review of key guidelines. J Clin Nurs. 2013;22:2366–86.
Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.
Michie S, Atkins L, West R: The Behaviour Change Wheel: A Guide To Designing Interventions. 2014. http://www.behaviourchangewheel.com/. Accessed 20 Jan 2015.
Douet L, Milne R, Anstee S, Habens F, Young A, Wright D. The completeness of intervention descriptions in published National Institute of Health Research HTA-funded trials: a cross-sectional study. BMJ Open. 2014;4:e003713.
Curran GM, Mukherjee S, Allee E, Owen RR. A process for developing an implementation intervention: QUERI Series. Implement Sci. 2008;3:17.
Connell LA, McMahon NE, Eng JJ, Watkins CL. Prescribing upper limb exercises after stroke: a survey of current UK therapy practice. J Rehabil Med. 2014;46:212–8.
Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46:81–95.
Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychol. 2008;27:379–87.
Ramsay P, Salisbury L, Merriweather J, Huby G, Rattray J, Hull A, et al. A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial. Trials. 2014;15:38.
Bonner C, Jansen J, McKinn S, Irwig L, Doust J, Glasziou P, et al. General practitioners’ use of different cardiovascular risk assessment strategies: a qualitative study. Med J Aust. 2013;199:485–9.
English M. Designing a theory-informed, contextually appropriate intervention strategy to improve delivery of paediatric services in Kenyan hospitals. Implement Sci. 2013;8:39.
Fuller C, Michie S, Savage J, McAteer J, Besser S, Charlett A, et al. The Feedback Intervention Trial (FIT)—improving hand-hygiene compliance in UK healthcare workers: a stepped wedge cluster randomised controlled trial. PLoS One. 2012;7:e41617.
Hawe P, Shiell A, Riley T. Complex interventions: how “out of control” can a randomised controlled trial be? BMJ. 2004;328:1561–3.
Sutton C. Developing and evaluating complex interventions. Matern Child Nutr. 2014;10:163–5.
Lomas J. Using ‘linkage and exchange’ to move research into policy at a Canadian foundation. Health Aff (Millwood). 2000;19:236–40.