Identifying clinicians' priorities for the implementation of best practices in cognitive rehabilitation post-acquired brain injury

Abstract

Purpose: To identify clinicians' perceptions of current levels of implementation of cognitive rehabilitation best practices, as well as individual and consensual group priorities for implementing cognitive rehabilitation interventions as part of a multi-site integrated knowledge translation initiative.

Method: A two-step consensus-building methodology was used, that is the Technique for Research of Information by Animation of a Group of Experts (TRIAGE), including a cross-sectional electronic survey followed by consensual in-person group discussions to identify implementation priorities from a list of evidence-based practices for cognitive rehabilitation following traumatic brain injury and stroke. Thirty-eight professionals from three rehabilitation teams (n = 9, 13 and 16) participated, including neuropsychologists, occupational therapists, speech-language pathologists, educators, clinical coordinators and program managers. Descriptive statistics were used to document the perceived levels of implementation as well as individual and consensual group priorities.

Results: Most of the best practices (81-100%) were perceived as at least partially implemented by a minimum of 50% of the participants but only 20-25% of the practices were considered fully implemented. Findings suggest that current practices are mostly consistent with general cognitive rehabilitation principles suggested in guidelines but that further efforts are needed to support the application of specific cognitive rehabilitation strategies and interventions. Executive function and self-awareness retraining, as well as interventions promoting the generalization of skills, were among the highest implementation priorities. Consensual in-person group discussions, included as part of the TRIAGE process, also helped to define and operationalize these best practices into more specific intervention components according to the teams' needs and priorities.

Conclusions: TRIAGE consensus-building methodology can be used to engage stakeholders and support clinicians' decision-making regarding the identification of implementation priorities in cognitive rehabilitation post-ABI in order to tailor the implementation process to local needs.IMPLICATIONS FOR REHABILITATIONThe Technique for Research of Information by Animation of a Group of Experts (TRIAGE) can be used to support clinicians' decision-making regarding the identification of implementation priorities in cognitive rehabilitation post-ABI.The combination of individual consultations followed by consensual in-person group discussions, as part of the TRIAGE process, may help clinicians in defining and operationalizing best practices into more specific intervention components to implement.Effective implementation strategies are needed to support the use of specific cognitive rehabilitation interventions in prioritized areas, such as executive function and self-awareness retraining, as well as generalization of skills.Some differences in clinicians' perceived priorities point up the importance of tailoring implementation to local needs and contexts from the early stages in the process.

Keywords: Best practices; acquired brain injury; cognitive rehabilitation; implementation; priority setting.