Conducting Implementation Research in Stroke Rehabilitation: A Case Example and Considerations for Study Design.

As neurorehabilitation research continues to grow, the field must ensure its scientific discoveries are implemented into routine clinical care. Without targeted efforts to increase the implementation of evidence into practice, patients may never see the benefits of interventions, assessments, and technologies developed in the confines of empirical studies. This article serves as a response to Lynch et al's 2018 Point of View piece in Neurorehabilitation and Neural Repair that underscored the urgent need for implementation studies to expedite the application of neurorehabilitation evidence in practice. To address this need, we provide the following 4 considerations investigators should contemplate when designing their own studies at the intersection of implementation and neurorehabilitation research: (a) consideration of guiding theories, models, and frameworks, (b) consideration of implementation strategies, (c) considerations of target outcomes, and (d) consideration of hybrid effectiveness-implementation designs. To conclude, we also provide a study exemplar to depict how these considerations can be integrated into the neurorehabilitation research field to narrow the evidence-to-practice gap.

Development and Refinement of the American Occupational Therapy Association's Knowledge Translation Toolkit.

IMPORTANCE: Occupational therapy practitioners are expected to translate promising discoveries from empirical research into routine practice with their clients. However, complex barriers can influence practitioners' knowledge translation (KT) efforts, leading the American Occupational Therapy Association's Evidence-Based Practice (EBP) group to develop the KT Toolkit tailored to the perceived needs of occupational therapists and occupational therapy assistants. OBJECTIVE: To identify common barriers to implementing EBPs and potential strategies to support EBP uptake. DESIGN: Cross-sectional survey. SETTING: United States. PARTICIPANTS: Occupational therapy practitioners. OUTCOMES AND MEASURES: Data underwent descriptive and directed content analysis, the latter of which was guided by the Consolidated Framework for Implementation Research. RESULTS: Occupational therapy survey respondents (N = 818) identified common EBP implementation barriers (e.g., lack of time and resources, difficulty understanding research findings). Initial KT Toolkit content was developed to address these barriers and included resources for searching for, analyzing, and applying evidence in practice. CONCLUSIONS AND RELEVANCE: Survey findings have informed the development of the KT Toolkit, which includes resources designed to support occupational therapy practitioners' EBP implementation efforts. This KT Toolkit is available at AOTA.org and will be continuously revised and updated on an ongoing basis. What This Article Adds: Several barriers limit the extent to which occupational therapy practitioners can implement evidence with their client populations. The KT Toolkit is directly informed by practitioner input and provides resources to support practitioners in their efforts to translate knowledge into real-world practice.

Evidence-Based Practice Implementation in Stroke Rehabilitation: A Scoping Review of Barriers and Facilitators.

IMPORTANCE: Despite advancements in stroke rehabilitation research, occupational therapy practitioners still face challenges with implementing research into routine practice. Although the development of evidence-based practices (EBPs) is one critical step along the knowledge translation continuum for the population of people with stroke, research is also needed to identify the most effective strategies for implementing EBPs with stroke survivors who are receiving occupational therapy services. OBJECTIVE: To synthesize research related to occupational therapy practitioners' implementation of EBPs in adult stroke rehabilitation. DATA SOURCES: We searched four electronic databases-CINAHL, MEDLINE, PubMed, and Academic Search Complete-and the peer-reviewed journal Implementation Science to identify relevant research studies. STUDY SELECTION AND DATA COLLECTION: Studies that met the following inclusion criteria were included in the scoping review: published between January 2003 and January 2018, addressed the adult stroke population, and examined the implementation of occupational therapy interventions. Data were abstracted on the basis of recommendations from the seminal review framework established by Arksey and O'Malley (2005). Thematic analysis identified themes that emerged from the included studies. FINDINGS: Twenty-five articles satisfied our inclusion parameters. Our analyses yielded three overarching themes: barriers to implementation, facilitators of implementation, and implementation strategies. Implementation strategies often consisted of multimodal knowledge translation training programs. CONCLUSION AND RELEVANCE: Although the stroke rehabilitation literature appears to have established the barriers to and facilitators of EBP implementation, greater attention to the identification of effective implementation strategies that promote the uptake of EBPs by occupational therapy practitioners is needed. WHAT THIS ARTICLE ADDS: This article summarizes the contextual factors and effective strategies that may influence practitioners' implementation of stroke research findings in real-world practice.

Narrowing the Gap: An Implementation Science Research Agenda for the Occupational Therapy Profession.

Despite advancements in occupational therapy research, the widespread research-to-practice gap continues to delay how quickly evidence-based practices are implemented in real-world clinical settings. Implementing research in practice is a complex process that mandates attention from all occupational therapy stakeholders; however, researchers are uniquely positioned to help minimize the 17-yr lag between scientific discovery and the implementation of research findings into practice. Our article serves as a response to Marr's (2017) Centennial Topics article, which proposed that purposeful efforts are needed to advocate for implementation research in occupational therapy. We provide an implementation science research agenda informed by concepts from the implementation science literature and suggest how researchers can structure methodologies to examine implementation-related outcomes and strategies. We provide explanations of gold-standard implementation outcomes and offer several recommendations for how researchers can report and disseminate implementation research findings to occupational therapy stakeholders.