The Feasibility of a Stroke Rehabilitation Educational Program for Occupational Therapy Students and Practitioners (Preprint)

BACKGROUND Gaps in knowledge translation of current evidence-based practice regarding stroke assessment and rehabilitation delivered through teletherapy can prevent occupational therapy students and practitioners from implementing current research findings to obtain the best possible results in practice. The purpose of this pilot feasibility study was to create an educational program to translate knowledge into practice about the remote delivery of stroke assessment and rehabilitation to occupational therapy students and practitioners. This study examined knowledge gained from specific educational modules and feedback of delivery with regards to design, feasibility, acceptability, and usability. Four areas of focus were addressed in the educational program including: knowledge translation (KT), task-oriented training (TOT), stroke assessments, and telerehabilitation. OBJECTIVE The purpose of this pilot feasibility study was to create an educational program to translate knowledge into practice about the remote delivery of stroke assessment and rehabilitation to occupational therapy students and practitioners. This study examined knowledge gained from specific educational modules and feedback of delivery with regards to design, feasibility, acceptability, and usability. Four areas of focus were addressed in the educational program including: knowledge translation (KT), task-oriented training (TOT), stroke assessments, and telerehabilitation. METHODS Two feasibility studies were conducted to assess knowledge gained via pretests and posttests of knowledge, followed by a System Usability Scale (SUS) and general feedback questionnaire. Participants in Study 1 were five current occupational therapy practitioners and one occupational therapy assistant. Initial recruitment of participants in Study 2 included ten current occupational therapy students, however only nine students participated in the modules. Four, one-hour modules were emailed weekly to participants over the course of four weeks, with each module covering a different topic (KT, TOT, stroke assessments, and telerehabilitation). Preliminary results were reviewed with median comparisons and nonparametric analyses of pretests and posttests of knowledge for each module. Descriptive statistics from the SUS and a general feedback questionnaire were used to gain overall comments regarding the educational program. RESULTS This study revealed statistically significant results related to increased scores of knowledge through a Wilcoxon Signed-Ranks Test for students, practitioners, and combined. The stroke assessments module for the practitioner study and the stroke assessments and telerehabilitation modules for the student study were found to be statistically significant for increases in knowledge. Task-oriented training, stroke assessments, and telerehabilitation were statistically significant for the combination of the two studies. The task-oriented training module for students and practitioners, and the knowledge translation and telerehabilitation modules for practitioners also demonstrated a notable trend towards significance. The majority of the educational modules had an above average score regarding feasibility as well as positive feedback for the educational program as a whole from the participants. CONCLUSIONS Overall, the results of this pilot study indicate that an online educational program is a feasible, informational method of increasing the translation of knowledge in the remote delivery of stroke assessment and rehabilitation. Occupational therapy students and practitioners found the information presented to be valuable and relevant to their future profession and current practice.

Abstract P155: The Network Effect on Inter-Facility Transfers Among Regional Stroke Certified Hospitals

Introduction and Purpose: Timely inter-facility transfer of thrombectomy-eligible patients is a mainstay of Stroke Systems of Care. We investigated transfer patterns among stroke certified hospitals in the Dallas-Fort Worth Metroplex (19 counties, 9,286 sq mi, >7.7 million people), by hospital network and stroke center status. Methods: In Feb 2020, all 44 North Central Texas Trauma Regional Advisory Council (NCTTRAC) hospitals identified network status, stroke designation and geographic location. Stroke Assessment and Large Vessel Occlusion (LVO) screening tool use was evaluated. The distance between the sending and receiving facility was calculated using GPS coordinates. If the closest Comprehensive Stroke Center (CSC) was not used, the average distance between the selected and the closest CSC was geospatially mapped via R statistical analysis software (Vienna, Austria) gmapsdistance package. Results: Of the 44 facilities, 6 were Acute Stroke Ready Hospitals (ASRHs), 27 were Primary Stroke Centers (PSCs), 11 were CSCs (Fig 1). Seventy-seven percent (n=34) were part of four hospital networks. All facilities used stroke assessment tools; 57% completed LVO screening. Seventeen percent of ASRHs (n=1) and 56% of PSCs (n=15) conducted inter-facility transfers. Sixty percent of non-network facilities transferred to the closest CSC. Of the remaining 40%, the average distance between the closest and the selected CSC was 1.5 miles (min max 0.2-2.9). Seventeen percent of network facilities transferred to the closest CSC. Among the remaining 83%, the average distance between the closest and the selected CSC was 4.1 miles (min-max 1-8). Conclusions: Non-network facility status increased the likelihood of transfer to the closest Comprehensive Stroke Center. Transfer distance variability among network facilities may contribute to delays in reperfusion therapy. Figure 1 . Transfer Patterns (in Blue) of Dallas Fort-Worth Metroplex Hospitals by Stroke Center Designation