Practice style traits: do they help explain practice behaviours of stroke rehabilitation professionals?

RATIONALE: The gap in knowledge translation from research to clinical practice is under scrutiny in stroke rehabilitation. One possible reason for this gap may be a poor understanding of clinicians' practice style traits and how they influence practice behaviours. OBJECTIVES: To identify the prevalence of practice style traits in physical therapists and occupational therapists working in stroke rehabilitation and, to explore associations between these traits and practice behaviours, where practice behaviours are defined as the clinicians' reasons for choosing assessments and interventions used in practice. The influence of more traditional personal and organizational factors on practice behaviours was also explored. DESIGN: Cross-sectional survey of a representative random sample of 243 clinicians (117 occupational therapists and 126 physical therapists) working across the continuum of stroke care in Ontario, Canada. METHODS: A telephone-administered validated clinical practice survey elicited information in 4 areas: practice style traits using the validated Practice Style Questionnaire, therapists' reasons for choosing assessments and interventions (practice behaviours), personal factors and organizational factors. RESULTS: For both disciplines, the most prevalent trait was pragmatist and the least prevalent was seeker. Seekers were the most likely to use evidence-based reasons for choosing assessments, but this finding did not reach significance (chi2 = 5.430, df = 3; p = 0.14). The most typical reason for choosing an intervention was that the clinician had learned it during professional training, an interesting finding given that approximately half of clinicians had more than 10 years of experience. Of the 21 potential explanatory variables examined, few explained clinicians' reasons for choosing assessments or interventions. CONCLUSION: While understanding practice traits is not going to be the single solution to closing the knowledge translation gap, it may help to guide best practice implementation strategies.

Occupational therapists' identification, assessment, and treatment of unilateral spatial neglect during stroke rehabilitation in Canada.

BACKGROUND AND PURPOSE: Unilateral spatial neglect (USN) is a disabling feature of stroke, and its identification and management are critical for optimizing patient outcomes. This study examined USN problem identification, assessment, and treatment among clinicians working in stroke rehabilitation. METHODS: This report was based on a Canada-wide survey of 253 occupational therapists providing inpatient stroke rehabilitation. RESULTS: Eighty percent (n=202) recognized USN as a potential problem, 27% (n=67) reported using standardized USN assessment tools, and 58% (n=147) indicated using USN interventions. Working on a stroke unit and younger age were among the variables explaining 7% to 19% of the variability in USN problem identification, assessment, and intervention use. CONCLUSIONS: Although USN problem identification was high, clinicians were unlikely to use standardized assessment tools or evidence-based interventions to effectively manage this serious impairment.

Assessment of unilateral spatial neglect post stroke in Canadian acute care hospitals: are we neglecting neglect?

OBJECTIVE: To estimate the prevalence, timing and frequency of use of standardized and non-standardized assessments to detect unilateral spatial neglect in acute care patients post stroke. DESIGN AND SETTING: Multicentred, retrospective study on medical charts from 10 randomly selected acute care hospitals in Ontario, Canada. SUBJECTS: Three hundred and twenty-four randomly selected medical charts of adult subjects with a primary diagnosis of stroke admitted in 2002 to the participating acute care hospitals. RESULTS: Out of 248 subjects who should have been assessed, 38% received some form of unilateral spatial neglect assessment. Only 13% were assessed with a standardized assessment and of these, 4% within 48 h post stroke or within 48 h of the patient regaining consciousness as recommended by clinical practice guidelines for stroke. Bivariate analysis found significant associations between severity of cognitive impairment and being ever assessed, as well as between the severity of motor deficits of the upper extremity and being ever assessed. CONCLUSION: Routine standardized assessment of unilateral spatial neglect during the acute care phase post stroke was not incorporated into daily practice in this study sample.