Combined Clinical and Home Rehabilitation: Case Report of an Integrated Knowledge-to-Action Study in a Dutch Rehabilitation Stroke Unit

BACKGROUND: There is growing awareness that the poor uptake of evidence in healthcare is not a knowledge-transfer problem but rather one of knowledge-production. This calls for re-examination of the evidence produced and assumptions that underpin existing Knowledge-To-Action (KTA)-activities. Accordingly, it has been advocated that KTA-studies should treat research knowledge and local practical knowledge with analytical impartiality.

PURPOSE: To illustrate the complexities in an evidence-informed improvement process of organized stroke care in a local rehabilitation setting.

CASE DESCRIPTION: A participatory action approach was used to co-create knowledge and engage local therapists in a two-way knowledge translation and multidirectional learning process. Evidence regarding rehabilitation stroke units was applied in a straightforward manner, since the setting met the criteria articulated in stroke unit reviews. Evidence on Early Supported Discharge (ESD) could not be directly applied because of differences in target group and implementation environment between the local and reviewed settings. ESD was tailored to the needs of severely affected stroke patients admitted to the local rehabilitation stroke unit by combining clinical and home rehabilitation (CCHR).

OUTCOMES: Local therapists welcomed CCHR, because it helped them make their task-specific training truly context-specific. Key barriers to implementation were travel time, logistical problems, partitioning walls between financing streams, and legislative procedures.

DISCUSSION: Improving local settings with available evidence is not a straightforward application process but rather a matter of searching, logical reasoning, and creatively working with heterogeneous knowledge sources in partnership with different stakeholders. Multiple organizational levels need to be addressed rather than focusing on therapists as sole site of change.