Implementation of Telerehabilitation in an Early Supported Discharge Stroke Rehabilitation Program before and during COVID-19: An Exploration of Influencing Factors
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Design
2.1.1. Theoretical Framework
2.1.2. Population
2.1.3. Telerehabilitation
2.1.4. Recruitment
2.1.5. Course of the Study
2.1.6. Data Collection
Sociodemographic Characteristics
Factors Perceived as Influencing Implementation
2.1.7. Data Analysis
2.1.8. Ethical Considerations
3. Results
3.1. Description of the Sample
3.2. Factors Perceived as Influencing Telerehabilitation Implementation
- I. Telerehabilitation
- Technology
- Clinical Activities
- II. Telerehabilitation Users
- Clients’ Characteristics
- Clinicians’ Characteristics
- III. Society and the Health Care System
- Changes related to COVID-19
- The ESD Program
- IV: TR Implementation Process
- Planning
- Factors Influencing Change of Practice
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Strategies | Practical Application | Domains of the CFIR | Classes of Strategies |
---|---|---|---|
Training | A two-hour in-person training session was offered to the ESD clinicians and clinical coordinator regarding the use of the REACTS© platform. Introduction to the platform, chat and video conversations and document sharing were demonstrated and practiced by participants. Presentations, demonstrations and practical exercises were used. | Individuals (clinicians) | Capacity building |
Transmission of professional guidelines regarding TR | Self-learning opportunities were sent to certain clinicians, such as the physical therapist. For example, certain professional orders (e.g., Quebec physiotherapy professional order) had created guidelines regarding the use of TR. These were transmitted to targeted clinicians. | Individuals (clinicians) | Dissemination strategy, capacity building |
Periodic presence of the research coordinator at weekly team meetings | The research coordinator participated regularly (once to twice a month) in the ESD team’s weekly meetings. The research coordinator observed the extent to which TR was discussed between the team and integrated in the services provided to clients. The research coordinator’s presence also gave the opportunity for the ESD team to raise issues related to the implementation process and for the research coordinator to find solutions (see “ongoing troubleshooting”). The research coordinator’s presence also acted as a reminder of the research project for the ESD team. | Process, individuals (clinicians) | Implementation process and integration strategies |
Integration of a TR-related question in the interdisciplinary intervention plan canvas | The question “Would TR be relevant for this client, and if not, why?” was added to the standardized document used by the ESD team to prepare the interdisciplinary intervention plan for each client. The question was raised by the clinical coordinator at the time of the meeting, and clinicians discussed the relevance of using TR or not with each client. | Inner context, individuals (coordinator) | Implementation process |
Ongoing troubleshooting | With frequent contact by email between the research coordinator and the ESD team, implementation issues were rapidly communicated and solutions were established collaboratively. Examples of troubleshooting were to resolve technical problems with the technology, putting clinicians in relation with technical support when needed, or ordering new material when needed. | Process, inner context | Implementation process, distributing messages |
TR guides and protocols for use of technology | Guides and protocols were created in collaboration with technology specialists from the organization to (1) orient the use of REACTS© in practice for clinicians, (2) facilitate teaching to clients regarding using the technology (e.g., using the iPad Pro and connecting to REACTS©) and (3) ease problem-solving when technical issues arise (e.g., who to call, which number). | Intervention | Developing and distributing messages and materials |
Establishment of a TR procedure and environmental configuration for clinicians | Specifically for when clinicians used TR to conduct team meetings (in the rehabilitation center) with clients (using TR in their home), guidelines regarding the configuration of the team meeting room, the material to use and how clinicians should be positioned to be visible by the clients via TR were established via a checklist and photographic descriptions. | Intervention, inner context | Developing and distributing messages and materials |
Pretesting technology before an attempt | For the majority of TR intervention, a pretest of the technology was realized between the clinician and a member of the research team. During these pretests, the quality of the internet connection, the functioning of the camera and microphone and the ability of the clinician to properly connect to the platform were assessed. The pretest was conclusive when TR technology was found to be functioning as intended. | Intervention | Integration strategies |
Regular contacts between research and ESD teams | Regular emails and live discussions were exchanged between the research and clinical coordinators, and when needed with clinicians, regarding the project. These contacts ranged from several times a week to once a month depending on the project phase and the needs of the ESD team. | Process | Integration strategies |
Bi-annual meetings between research and ESD managers | Meetings were organized between the research team and the coordinator and managers of the ESD program in order to discuss the implementation project and the main barriers and facilitators that were experienced, and to plan the interventions that needed to be realized in order for the project to function optimally. | Process | Implementation process strategies |
Adapted support for TR sessions | At the request of the clinical team, a member of the research team was available to be present in preparation, during and after the TR session (either physically or virtually) to support clinicians. | Intervention, individuals (clinicians) | Integration strategies |
Participant ID | Discipline | Years of Experience in Stroke Rehabilitation |
---|---|---|
1 | Occupational therapist | 1 |
2 | Occupational therapist | 5 |
3 | Special care counsellor | 3 |
4 | Social worker | 2 |
5 | Social worker | 10 |
6 | Speech language pathologist | 13 |
7 | Physical therapist | 10 |
8 | Clinical coordinator | 15 |
9 | Manager | 36 |
Categories with CFIR Domain | Themes | Sub-Themes |
---|---|---|
I. Telerehabilitation (CFIR domain: Intervention) | Technology | Internet connection |
Platform | ||
Equipment | ||
Clinical activities | Assessment | |
Intervention | ||
II. Telerehabilitation users (CFIR domain: Individual characteristics) | Clients’ characteristics | Socio-demographic characteristics |
Post-stroke condition | ||
Availability of a caregiver | ||
Clinicians’ characteristics | Therapeutic relationship | |
Beliefs and attitudes | ||
Scope of practice | ||
III. Society and healthcare system (CFIR domain: inner and outer stings) | Changes related to COVID-19 | Impact on perceptions towards TR benefits |
Impact on ESD services’ expectations | ||
The ESD as a buffer for the stroke rehabilitation continuum | ||
The ESD program | Nature of the service | |
Interdisciplinary teamwork | ||
IV. TR Implementation process (CFIR domain: implementation process) | Planning | Collaborating with researchers |
Telerehabilitation adaptation methods | ||
Factors influencing change of practice | Staff mobility | |
Champions | ||
Innovation culture |
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Auger, L.-P.; Moreau, E.; Côté, O.; Guerrera, R.; Rochette, A.; Kairy, D. Implementation of Telerehabilitation in an Early Supported Discharge Stroke Rehabilitation Program before and during COVID-19: An Exploration of Influencing Factors. Disabilities 2023, 3, 87-104. https://doi.org/10.3390/disabilities3010007
Auger L-P, Moreau E, Côté O, Guerrera R, Rochette A, Kairy D. Implementation of Telerehabilitation in an Early Supported Discharge Stroke Rehabilitation Program before and during COVID-19: An Exploration of Influencing Factors. Disabilities. 2023; 3(1):87-104. https://doi.org/10.3390/disabilities3010007
Chicago/Turabian StyleAuger, Louis-Pierre, Emmanuelle Moreau, Odile Côté, Rosalba Guerrera, Annie Rochette, and Dahlia Kairy. 2023. "Implementation of Telerehabilitation in an Early Supported Discharge Stroke Rehabilitation Program before and during COVID-19: An Exploration of Influencing Factors" Disabilities 3, no. 1: 87-104. https://doi.org/10.3390/disabilities3010007
APA StyleAuger, L. -P., Moreau, E., Côté, O., Guerrera, R., Rochette, A., & Kairy, D. (2023). Implementation of Telerehabilitation in an Early Supported Discharge Stroke Rehabilitation Program before and during COVID-19: An Exploration of Influencing Factors. Disabilities, 3(1), 87-104. https://doi.org/10.3390/disabilities3010007