Implementation of activities of daily living retraining for individuals in post-traumatic amnesia

Abstract

Background Despite evidence of the efficacy of activities of daily living (ADL) retraining during post-traumatic amnesia (PTA) following traumatic brain injury (TBI), utilisation of this intervention in practice is unclear. Utilising an implementation science framework, the Consolidated Framework for Implementation Research, this study explored efforts to translate ADL retraining during PTA into the clinical practice of occupational therapists (OTs) working in TBI rehabilitation settings across Australia. Methods Participants were 44 OTs who attended a day-long training workshop that included knowledge and skill-based content regarding ADL retraining during PTA. Baseline and post-training ratings were completed including evaluation of workshop utility, and skill and knowledge-based competencies relevant to the intervention. Approximately 2 years later, nine trained OTs and two administrators were interviewed to explore the results of implementing the intervention. Results Overall, the training workshop was rated as being helpful and OT ratings of confidence (P < 0.001) and competencies (P < 0.001) significantly improved from baseline to post-workshop. At follow-up, thematic analysis of interviews identified themes related to implementing the intervention as it pertains to patients in PTA, OTs delivering the intervention and the organisational context. Various facilitators and barriers to translation were identified. Participants indicated a positive view of the clinical use of the intervention and development of their knowledge and skills, with the intervention benefiting those in PTA. Despite this, factors such as time, resourcing, team training, and rehabilitation-setting processes posed significant barriers. Conclusion Multiple barriers were identified in implementation of ADL retraining during PTA and require consideration to facilitate translation and promote best practice.