Elizabeth Linkewich1, Lisa Avery2, Jorge Rios3, Sara E McEwen4. 1. Regional Stroke Centre, Sunnybrook Health Sciences Centre, Toronto, ON; Practice-Based Research, Sunnybrook Research Institute, Toronto, ON; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON. Electronic address: beth.linkewich@sunnybrook.ca. 2. Avery Information Services Ltd., Orillia, ON. 3. St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON. 4. St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON; Department of Physical Therapy, University of Toronto, Toronto, ON; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
Abstract
OBJECTIVE: To examine the odds of persons with stroke achieving minimal clinically important difference (MCID) in functional independence during inpatient rehabilitation relative to cognitive impairment (CI) severity, site, and rehabilitation teams' exposure to a Cognitive Orientation to daily Occupational Performance (CO-OP) knowledge translation (KT) intervention. DESIGN: A pre-post observational study was conducted using data from a centralized referral system. Our research team implemented a CO-OP KT intervention as part of a larger study aimed at training teams to use the CO-OP approach. SETTING: Five inpatient rehabilitation units. PARTICIPANTS: Cases extracted from a centralized referral system from the 5 participating units. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The FIM instrument data from 12 months preintervention and 6 months postintervention were analyzed. A logistic regression was performed to determine the odds ratios (ORs) for achieving MCID based on sample cohort (historical control not exposed to CO-OP KT vs post-CO-OP KT intervention), controlling for site and severity of CI. RESULTS: A model that considered the intervention, admission score, CI severity, and site was the best fit for the cases analyzed. Those with severe CI were less likely to achieve FIM total MCID compared to those with no CI (P=<.001; OR=.18; 95% confidence interval, .09-.39). Taking site and CI into account, cases post CO-OP KT intervention were significantly more likely to achieve MCID on FIM motor (P=.048; OR=1.4; 95% confidence interval, 1.00-1.98) than historical controls. CONCLUSION: The CO-OP KT intervention is associated with increased odds of achieving MCID in the FIM motor subscale in inpatient stroke rehabilitation.
OBJECTIVE: To examine the odds of persons with stroke achieving minimal clinically important difference (MCID) in functional independence during inpatient rehabilitation relative to cognitive impairment (CI) severity, site, and rehabilitation teams' exposure to a Cognitive Orientation to daily Occupational Performance (CO-OP) knowledge translation (KT) intervention. DESIGN: A pre-post observational study was conducted using data from a centralized referral system. Our research team implemented a CO-OP KT intervention as part of a larger study aimed at training teams to use the CO-OP approach. SETTING: Five inpatient rehabilitation units. PARTICIPANTS: Cases extracted from a centralized referral system from the 5 participating units. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The FIM instrument data from 12 months preintervention and 6 months postintervention were analyzed. A logistic regression was performed to determine the odds ratios (ORs) for achieving MCID based on sample cohort (historical control not exposed to CO-OP KT vs post-CO-OP KT intervention), controlling for site and severity of CI. RESULTS: A model that considered the intervention, admission score, CI severity, and site was the best fit for the cases analyzed. Those with severe CI were less likely to achieve FIM total MCID compared to those with no CI (P=<.001; OR=.18; 95% confidence interval, .09-.39). Taking site and CI into account, cases post CO-OP KT intervention were significantly more likely to achieve MCID on FIM motor (P=.048; OR=1.4; 95% confidence interval, 1.00-1.98) than historical controls. CONCLUSION: The CO-OP KT intervention is associated with increased odds of achieving MCID in the FIM motor subscale in inpatient stroke rehabilitation.
Authors: Elizabeth Linkewich; Jorge Rios; Kay-Ann Allen; Lisa Avery; Deirdre R Dawson; Michelle Donald; Mary Egan; Anne Hunt; Katelyn Jutzi; Sara McEwen Journal: PLoS One Date: 2022-09-01 Impact factor: 3.752