Table 2.

Characteristics of Articles Examining Occupational and Physical Therapy Practitioners’ Implementation of Stroke Rehabilitation EBPs

Author/Year	Type of EBP	Implementation Approach	Methodology	Findings
Bayley et al. (2012)	Evidence-based recommendations for arm and leg rehabilitation after stroke	Local facilitators; workshop; consultation with KT experts; implementation toolkit	Qualitative; focus groups with practitioners	Barriers to implementation: decreased resources (staff, time, equipment, training); decreased communication among leadership
Connell, McMahon, Harris, et al. (2014)	GRASP designed to support higher exercise intensity in inpatient settings	N/A	Qualitative; interviews with practitioners	Facilitators of implementation: available online resources; access to leaders and experts; perceived value of GRASP Barriers to implementation: Inconsistent adherence to GRASP
Connell, McMahon, Watkins, et al. (2014)	GRASP	N/A	Descriptive; cross-sectional survey	Facilitator of implementation of perceived value of GRASP
Doyle & Bennett (2014)	ULPSSI management	Workshop drawn from Adult Learning Theory and Theory of Planned Behavior	Single group pretest–posttest design	Implementation strategies: Workshop led to improved knowledge of, attitude toward, and confidence in capabilities with ULPSSI; also led to higher intended behaviors regarding ULPSSI
Gustafsson & McKenna (2003)	Practice related to support devices, PROM, Bobath techniques, and static positional stretches	N/A	Descriptive; cross-sectional survey	Barriers to implementation: inconsistent adherence to best practice recommendations; cost of recommendations
Korner-Bitensky et al. (2007)	Best practice utilization behaviors in rehabilitation	N/A	Descriptive; cross-sectional survey	Barriers to implementation: lack of resources (time and staff); lack of perceived value of EBP
Korner-Bitensky et al. (2008)	StrokEngine	N/A	Descriptive; cross-sectional	Facilitators of implementation: availability of resources (online)
Kristensen & Hounsgaard (2014)	General EBP for stroke rehab	Audit and feedback	Descriptive; chart audits	Implementation intervention: audits and feedback positively influenced use of EBPs
Kristensen et al. (2016)	General EBP for stroke rehab	N/A	Qualitative; field observations, interviews, focus groups	Barriers to implementation: complexity of stroke-related assessments; lack of adaptability of assessments Facilitators of implementation: engagement from organizational leadership; perceived value of EBP
Levac et al. (2016a)	VR in stroke rehabilitation	Multimodal KT intervention including computer-based learning, hands-on learning sessions, experiential learning, email reminders; mentorship	Single group pretest–posttest design	Barriers to implementation: limited resources (time, LOS, equipment); VR complexity; VR appropriateness Facilitators of implementation: client engagement in VR Implementation intervention: Multimodal KT intervention led to increased confidence in using VR
Levac et al. (2016b)	Motor learning approach within VR	Multimodal KT intervention including self-paced e-learning, hands-on learning sessions, VR sessions with stroke survivors, didactic reminders	Single group pretest–posttest design	Implementation intervention: Multimodal KT intervention led to increased knowledge regarding motor learning and VR
Masterson-Algar et al. (2014)	A complex ADL intervention	N/A	Qualitative; semistructured interviews	Facilitators of implementation: building relationships among staff led to improved adherence to the intervention; being able to modify the physical environment also led to improved adherence
McCann et al. (2009)	Stroke performance indicators	Establishment of a stroke-specific hospital unit	Single group pretest–posttest design	Implementation intervention: Establishing a designated stroke unit led to increased compliance with performance indicators and enhanced stroke survivor outcomes
McCluskey et al. (2015)	Outdoor therapy sessions	Audit and feedback	Observational	Barriers to implementation: decreased adherence to conducting therapy sessions in the outdoor environment
McCluskey et al. (2016)	Outdoor mobility clinical guideline	Intervention group: multimodal KT intervention including training workshop, implementation barrier discussion, printed education materials, audit and feedback with medical records, 1-hr booster session Control group: printed copy of the 2010 stroke guidelines delivered by mail	Experimental; cluster RCT	Implementation intervention: The multimodal KT intervention did not change community teams’ behavior in delivering outdoor mobility sessions with stroke survivors
McCluskey et al. (2013)	Multiple stroke guidelines	N/A	Qualitative; semistructured focus groups (6) and individual interviews (2)	Barriers to implementation: beliefs about potential negative outcomes or lack of memory support to facilitate good practice and documentation habits; limited knowledge of EBP; poor prioritization of EBP; and limited resources, such as time or patient literature Facilitators of implementation: beliefs about potential positive outcomes of a guideline, knowing EBP options, clinician motivation to use EBP, availability of resources
McEwen et al. (2005)	General stroke EBP utilization	The Rehabilitation Education Program for Stroke was administered; it combined a self-directed online learning module with support from peer mentors, technical skill workshops, and organizational supports	Single group; pretest–posttest design	Implementation intervention: Multimodal KT intervention positively influenced the use of stroke rehabilitation practices
Munce et al. (2017)	Stroke clinical guidelines	N/A	Qualitative; semistructured focus groups	Barriers to implementation: lack of familiarity with and lack of beliefs in the guidelines; environmental factors; lack of communication and collaboration Facilitators of implementation: familiarity with and perceived value of the guidelines; team communication and collaboration
Petzold et al. (2012)	Poststroke USN	7-hr in-person interactive workshop; 8-wk reinforcement period	Single group pretest–posttest design	Implementation intervention: A multimodal KT intervention can improve practitioners’ knowledge of how to manage poststroke USN
Petzold et al. (2014)	USN treatment	N/A	Qualitative; focus groups	Barriers to implementation: staff and managerial factors, limited resources, client factors, lack of practitioner training, decreased perceived value of USN treatment Facilitators of implementation: access to resources, supportive management, access to continuing education, perceived value of USN treatment, client factors
Read & Levy (2006)	Stroke care pathways	Stroke care pathway implementation	Single group pretest–posttest design	Implementation intervention: Establishing stroke care pathways appears to improve the process of stroke care
Russell et al. (2018)	Cross-education, the practice of improving an untrained muscle through training of the same muscle on the opposite side of the body	N/A	Qualitative; focus groups	Facilitators of implementation: perceived value of intervention
Salbach et al. (2017)	18 stroke rehab guidelines	Intervention group: KT program including 4 hr of live support from trained facilitators over 16 mo, small group education sessions with stroke teams, booklets on EBP guidelines and protocols, web-based teleconferences Control group: guideline booklets, video, handbook	Experimental, cluster RCT	Implementation intervention: Of the 18 guidelines, the implementation of only 2 guidelines improved in the intervention group; in the control group, the implementation of 1 guideline improved
Schmid et al. (2008)	Stroke rehabilitation guidelines	N/A	Descriptive; cross-sectional survey	Barriers to implementation: lack of knowledge and skills regarding stroke guidelines
Scobbie et al. (2013)	Goal setting and action planning framework	N/A	Qualitative; interviews	Barriers to implementation: lack of time, lack of confidence in using a new outcome measure, difficulty habitually integrating new interventions into clinical practice, logistical challenges (e.g., inability to find intervention materials efficiently), limited applicability to patients with cognitive or communication impairments Facilitators of implementation: previous experience with similar intervention, confidence in technique, rehabilitation assistant involvement, perceived value of goal setting and action planning framework

Note. ADL = activities of daily living; EBP = evidence-based practice; GRASP = Graded Repetitive Arm Supplementary Program; KT = knowledge translation; LOS = length of stay; N/A = not applicable; PROM = passive range of motion; RCT = randomized controlled trial; ULPSSI = upper limb poststroke sensory impairment; USN = unilateral spatial neglect; VR = virtual reality.