Factors that influence oral hygiene care with hospitalised stroke patients: a mixed methods study

Survivors of stroke experience poor oral health during and following hospitalisation. Health professionals consistently report that oral hygiene is complex. Interventions aiming to improve the delivery of oral hygiene care by health professionals rarely use a theoretically driven approach. This study reports the first phase in an intervention development and uses the action, actor, context, target, time (AACTT) framework and theoretical domains framework (TDF) to understand who needs to do what differently in the delivery of oral hygiene care with hospitalised stroke survivors. Mixed methods including analysis of oral health policies and clinical guidelines using the AACTT framework, focus group discussions using the TDF and audit of 60 medical records. Policies and guidelines lack specificity regarding what oral hygiene care is and who should be responsible. Health professionals have low beliefs in their capabilities and experience numerous contextual barriers. More than 40% of patients had no documented evidence of oral hygiene care. This study used a theoretically driven approach to identify barriers and enablers to health professional delivery of oral hygiene care with stroke survivors. Interventions aiming to improve clinical practice should target beliefs about capabilities, improved access to resources and detailed oral hygiene clinical guidelines.Implications for rehabilitationSurvivors of stroke experience poor oral health which can contribute to further strokes, cardiovascular disease and mortality.Health care professionals report difficulties in delivering oral hygiene care to hospitalised stroke survivors and clinical guidelines lack detail regarding oral health assessments, interventions and training.Interventions aiming to improve the delivery of oral hygiene care should target health professional beliefs about their capabilities using strategies such as behavioural practice.Resources specific to oral hygiene care for more complex patients, including suctioning toothbrushes, should be readily accessible for health professional use.Clinical guidelines and policies on oral hygiene care should include detail about training content, assessments tools and how to adapt information for patients with complex impairments. Survivors of stroke experience poor oral health which can contribute to further strokes, cardiovascular disease and mortality. Health care professionals report difficulties in delivering oral hygiene care to hospitalised stroke survivors and clinical guidelines lack detail regarding oral health assessments, interventions and training. Interventions aiming to improve the delivery of oral hygiene care should target health professional beliefs about their capabilities using strategies such as behavioural practice. Resources specific to oral hygiene care for more complex patients, including suctioning toothbrushes, should be readily accessible for health professional use. Clinical guidelines and policies on oral hygiene care should include detail about training content, assessments tools and how to adapt information for patients with complex impairments.</p

sj-docx-1-cre-10.1177_02692155231172295 - Supplemental material for Dose, Content, and Context of Usual Care in Stroke Upper Limb Motor Interventions: A Systematic Review

Supplemental material, sj-docx-1-cre-10.1177_02692155231172295 for Dose, Content, and Context of Usual Care in Stroke Upper Limb Motor Interventions: A Systematic Review by Sarah P Newton, Emily J Dalton, Jia Y Ang, Marlena Klaic, Vincent Thijs and Kathryn S Hayward in Clinical Rehabilitation</p

Additional file 1 of Aligning organisational priorities and implementation science for cancer research

Supplementary Material 1

sj-docx-1-cre-10.1177_02692155231197510 - Supplemental material for Is there a relationship between ‘getting up and dressed’ and functional and physical outcomes in geriatric rehabilitation inpatients? A quasi-experimental study

Supplemental material, sj-docx-1-cre-10.1177_02692155231197510 for Is there a relationship between ‘getting up and dressed’ and functional and physical outcomes in geriatric rehabilitation inpatients? A quasi-experimental study by Rose Goonan, Edward Mohandoss, Celia Marston, Jaqueline Kay, Anurika Priyanjali De Silva, Andrea B. Maier, Esmee Reijnierse and Marlena Klaic in Clinical Rehabilitation</p

sj-png-3-cre-10.1177_02692155231197510 - Supplemental material for Is there a relationship between ‘getting up and dressed’ and functional and physical outcomes in geriatric rehabilitation inpatients? A quasi-experimental study

Supplemental material, sj-png-3-cre-10.1177_02692155231197510 for Is there a relationship between ‘getting up and dressed’ and functional and physical outcomes in geriatric rehabilitation inpatients? A quasi-experimental study by Rose Goonan, Edward Mohandoss, Celia Marston, Jaqueline Kay, Anurika Priyanjali De Silva, Andrea B. Maier, Esmee Reijnierse and Marlena Klaic in Clinical Rehabilitation</p

sj-png-2-cre-10.1177_02692155231197510 - Supplemental material for Is there a relationship between ‘getting up and dressed’ and functional and physical outcomes in geriatric rehabilitation inpatients? A quasi-experimental study

Supplemental material, sj-png-2-cre-10.1177_02692155231197510 for Is there a relationship between ‘getting up and dressed’ and functional and physical outcomes in geriatric rehabilitation inpatients? A quasi-experimental study by Rose Goonan, Edward Mohandoss, Celia Marston, Jaqueline Kay, Anurika Priyanjali De Silva, Andrea B. Maier, Esmee Reijnierse and Marlena Klaic in Clinical Rehabilitation</p

Application of the extended technology acceptance model to explore clinician likelihood to use robotics in rehabilitation

Evidence suggests that patients with upper limb impairment following a stroke do not receive recommended amounts of motor practice. Robotics provide a potential solution to address this gap, but clinical adoption is low. The aim of this study was to utilize the technology acceptance model as a framework to identify factors influencing clinician adoption of robotic devices into practice. Mixed methods including survey data and focus group discussions with allied health clinicians whose primary caseload was rehabilitation of the neurologically impaired upper limb. Surveys based on the technology acceptance measure were completed pre/post exposure to and use of a robotic device. Focus groups discussions based on the theory of planned behaviour were conducted at the conclusion of the study. A total of 34 rehabilitation clinicians completed the surveys with pre-implementation data indicating that rehabilitation clinicians perceive robotic devices as complex to use, which influenced intention to use such devices in practice. The focus groups found that lack of experience and time to learn influenced confidence to implement robotic devices into practice. This study found that perceived usefulness and perceived ease of use of a robotic device in clinical rehabilitation can be improved through experience, training and embedded technological support. However, training and embedded support are not routinely offered, suggesting there is a discordance between current implementation and the learning needs of rehabilitation clinicians.IMPLICATIONS FOR REHABILITATIONPatients do not receive adequate amounts of upper limb motor practice following a stroke, and although robotic devices have the potential to address this gap, clinical adoption is low.The technology acceptance model identified that clinicians perceive robotic devices to be complex to use with current implementation efforts failing to consider their training needs.Implementation adoption of robotic devices in rehabilitation should be supported with adequate training and technological support if sustainable practice change is to be achieved. Patients do not receive adequate amounts of upper limb motor practice following a stroke, and although robotic devices have the potential to address this gap, clinical adoption is low. The technology acceptance model identified that clinicians perceive robotic devices to be complex to use with current implementation efforts failing to consider their training needs. Implementation adoption of robotic devices in rehabilitation should be supported with adequate training and technological support if sustainable practice change is to be achieved.</p