Implementing a complex rehabilitation intervention in a stroke trial: a qualitative process evaluation of AVERT

Journal article


Luker, Julie A., Craig, Louise E., Bennett, Leanne, Ellery, Fiona, Langhorne, Peter, Wu, Olivia and Bernhardt, Julie. (2016) Implementing a complex rehabilitation intervention in a stroke trial: a qualitative process evaluation of AVERT. BMC Medical Research Methodology. 16(52), pp. 1 - 11. https://doi.org/10.1186/s12874-016-0156-9
AuthorsLuker, Julie A., Craig, Louise E., Bennett, Leanne, Ellery, Fiona, Langhorne, Peter, Wu, Olivia and Bernhardt, Julie
Abstract

Background: The implementation of multidisciplinary stroke rehabilitation interventions is challenging, even when the intervention is evidence-based. Very little is known about the implementation of complex interventions in rehabilitation clinical trials. The aim of study was to better understand how the implementation of a rehabilitation intervention in a clinical trial within acute stroke units is experienced by the staff involved. This qualitative process evaluation was part of a large Phase III stroke rehabilitation trial (AVERT). Methods: A descriptive qualitative approach was used. We purposively sampled 53 allied health and nursing staff from 19 acute stroke units in Australia, New Zealand and Scotland. Semi-structured interviews were conducted by phone, voice-internet, or face to face. Digitally recorded interviews were transcribed and analysed by two researchers using rigorous thematic analysis. Results: Our analysis uncovered ten important themes that provide insight into the challenges of implementing complex new rehabilitation practices within complex care settings, plus factors and strategies that assisted implementation. Themes were grouped into three main categories: staff experience of implementing the trial intervention, barriers to implementation, and overcoming the barriers. Participation in the trial was challenging but had personal rewards and improved teamwork at some sites. Over the years that the trial ran some staff perceived a change in usual care. Barriers to trial implementation at some sites included poor teamwork, inadequate staffing, various organisational barriers, staff attitudes and beliefs, and patient-related barriers. Participants described successful implementation strategies that were built on interdisciplinary teamwork, education and strong leadership to ‘get staff on board’, and developing different ways of working. Conclusions: The AVERT stroke rehabilitation trial required commitment to deliver an intervention that needed strong collaboration between nurses and physiotherapists and was different to current care models. This qualitative process evaluation contributes unique insights into factors that may be critical to successful trials teams, and as AVERT was a pragmatic trial, success factors to delivering complex intervention in clinical practice.

Keywordsstroke; rehabilitation; clinical trials; clinical research protocol; qualitative research; implementation
Year2016
JournalBMC Medical Research Methodology
Journal citation16 (52), pp. 1 - 11
PublisherBiomed Central Ltd
ISSN1471-2288
Digital Object Identifier (DOI)https://doi.org/10.1186/s12874-016-0156-9
Scopus EID2-s2.0-84977646112
Open accessOpen access
Page range1 - 11
Research GroupNursing Research Institute
Publisher's version
Additional information

© 2016 Luker et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Place of publicationUnited Kingdom
Permalink -

https://acuresearchbank.acu.edu.au/item/894z3/implementing-a-complex-rehabilitation-intervention-in-a-stroke-trial-a-qualitative-process-evaluation-of-avert

  • 0
    total views
  • 1
    total downloads
  • 0
    views this month
  • 1
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

Does the addition of non-approved inclusion and exclusion criteria for rtPA impact treatment rates? Findings in Australia, the UK, and the USA
Craig, Louise E., Middleton, Sandy, Hamilton, Helen, Cudlip, Fern, Swatzell, Victoria, Alexandrov, Andrei V., Lightbody, Elizabeth, Watkins, Caroline, Philip, Sheeba, Cadihac, Dominique A., McInnes, Elizabeth, Dale, Simeon and Alexandrov, Anne W.. (2019) Does the addition of non-approved inclusion and exclusion criteria for rtPA impact treatment rates? Findings in Australia, the UK, and the USA. Interventional Neurology. 8(1), pp. 1 - 12. https://doi.org/10.1159/000493020
Testing a systematic approach to identify and prioritise barriers to successful implementation of a complex healthcare intervention
Craig, Louise E., Churilov, Leonid, Olenko, Liudmyla, Cadilhac, Dominique A., Grimley, Rohan, Dale, Simeon, Martinez-Garduno, Cintia, McInnes, Elizabeth, Considine, Julie, Grimshaw, Jeremy M. and Middleton, Sandy. (2017) Testing a systematic approach to identify and prioritise barriers to successful implementation of a complex healthcare intervention. BMC Medical Research Methodology. 17(1), pp. 1 - 14. https://doi.org/10.1186/s12874-017-0298-4
Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): The T3 Trial
Craig, Louise E., Taylor, Natalie, Grimley, Rohan, Cadilhac, Dominique A., McInnes, Elizabeth, Phillips, Rosemary, Dale, Simeon, O'Connor, Denise, Levi, Chris, Fitzgerald, Mark, Considine, Julie, Grimshaw, Jeremy M., Gerraty, Richard, Cheung, N. Wah, Ward, Jeanette and Middleton, Sandy. (2017) Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): The T3 Trial. Implementation Science. 12(1), pp. 1 - 17. https://doi.org/10.1186/s13012-017-0616-6
Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF)
Craig, Louise, McInnes, Elizabeth, Taylor, Natalie, Grimley, Rohan, Cadilhac, Dominique, Considine, Julie and Middleton, Sandy. (2016) Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF). Implementation Science. 11(157), pp. 1 - 18. https://doi.org/10.1186/s13012-016-0524-1
Triage, treatment and transfer of patients with stroke in emergency department trial (the T3 Trial): a cluster randomised trial protocol
Middleton, Sandy, Levi, Chris, Dale, Simeon, Chung, N., McInnes, Elizabeth, Considine, Julie, D'Este, Catherine, Cadilhac, Dominique, Grimshaw, Jeremy, Gerraty, Richard, Craig, Louise, Schadewaldt, Verena, McElduff, Patrick, Fitzgerald, Mark, Quinn, Clare, Cadigan, Greg, Denisenko, Sonia, Longworth, Mark and Ward, Janette. (2016) Triage, treatment and transfer of patients with stroke in emergency department trial (the T3 Trial): a cluster randomised trial protocol. Implementation Science. 11(139), pp. 1 - 9. https://doi.org/10.1186/s13012-016-0503-6
Approaches to economic evaluations of stroke rehabilitation
Craig, Louise, Wu, Olivia, Bernhardt, Julie and Langhorne, Peter. (2014) Approaches to economic evaluations of stroke rehabilitation. International Journal of Stroke. 9(1), pp. 88 - 100. https://doi.org/10.1111/ijs.12041
Developing and validating a predictive model for stroke progression
Craig, Louise, Wu, O., Gilmore, Harper, Barber, Mark and Langhorne1, Peter. (2011) Developing and validating a predictive model for stroke progression. Cerebrovascular Diseases. https://doi.org/10.1159/000334473
Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial) : 5-Year results
Moss, J. G., Cooper, K. G., Khaund, A., Murray, L. S., Murray, G. D., Wu, O., Craig, Louise E. and Lumsden, M. A.. (2011) Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial) : 5-Year results. BJOG: An International Journal of Obstetrics and Gynaecology. 118(8), pp. 936 - 944. https://doi.org/10.1111/j.1471-0528.2011.02952.x
Safety and efficacy of percutaneous vertebroplasty in malignancy: A systematic review
Chew, C, Craig, Louise, Edwards, R, Moss, John and O'Dwyer, P. (2011) Safety and efficacy of percutaneous vertebroplasty in malignancy: A systematic review. Clinical Radiology. 66(1), pp. 63 - 72. https://doi.org/10.1016/j.crad.2010.09.011
Developing and validating a predictive model for stroke progression
Craig, Louise, Wu, O., Gilmore, Harper, Barber, Mark and Langhorne, Peter. (2011) Developing and validating a predictive model for stroke progression. Cerebrovascular Diseases Extra. 1(1), pp. 105 - 114. https://doi.org/10.1159/000334473
Predictors of poststroke mobility : Systematic review
Craig, Louise E., Wu, O., Bernhardt, Julie and Langhorne, Peter. (2011) Predictors of poststroke mobility : Systematic review. International Journal of Stroke. 6(4), pp. 321 - 327. https://doi.org/10.1111/j.1747-4949.2011.00621.x
Predictors of poststroke mobility : Systematic review
Craig, Louise, Wu, Olivia, Bernhardt, Julie and Langhorne, Peter. (2011) Predictors of poststroke mobility : Systematic review. International Journal of Stroke. 6(4), pp. 321 - 327. https://doi.org/10.1111/j.1747-4949.2011.00621.x
Early mobilisation after stroke : An example of an individual patient data meta-analysis of a complex intervention
Craig, Louise, Bernhardt, Julie, Langhorne, Peter and Wu, Olivia. (2010) Early mobilisation after stroke : An example of an individual patient data meta-analysis of a complex intervention. Stroke: a journal of cerebral circulation (online version). https://doi.org/10.1161/STROKEAHA.110.588244
Early mobilisation after stroke : An example of an individual patient data meta-analysis of a complex intervention
Craig, Louise. (2010) Early mobilisation after stroke : An example of an individual patient data meta-analysis of a complex intervention. Stroke: a journal of cerebral circulation. 41(11), pp. 2632 - 2636. https://doi.org/10.1161/STROKEAHA.110.588244
The interaction between policy and education
Craig, Louise and Smith, Lorraine. (2008) The interaction between policy and education. Nurse Education Today.