Examining Reach, Adoption, & Implementation of a Recovery Ruler That Visualizes Assessment Results at Three Disorders of Consciousness Programs

PURPOSE: People in disorders of consciousness (DoC) cannot speak for themselves and rely on rehabilitation practitioners (RPs), including occupational therapists, and family care partners (FCPs) to exchange information when making clinical decisions. The Recovery Ruler (RR) visualizes Coma Recovery Scale-Revised (CRS-R) data and embeds person-centered measurement principles. Three DoC programs tailored the RR to reduce clinical redundancy and made it easier to understand. In this study, we used the RE-AIM implementation science framework to examine reach, adoption, and implementation of the RR at three DoC programs.

DESIGN: Longitudinal, descriptive survey study. We used convenience sampling; all eligible rehabilitation practitioners (RPs) (i.e., those who use CRS-R) were invited to participate after listening to a RR presentation.

METHOD: We described the RR to 58 RPs. RPs enrolled and completed surveys weekly for 12 weeks and monthly for another 3 months. RPs reported if they used the CRS-R and if so whether they used the RR. We examined: 1) Reach: % of eligible RPs who participated in the RR study; 2) Adoption: % of study participants who adopted the RR at least once; 3) Implementation rate: % of opportunities when the RR was used in conjunction with the CRS-R.

RESULTS: 23 RPs of the 58 enrolled in the study (Reach = 40%). One RP completed surveys but never administered a CRS-R. Two RPs never completed surveys. 19 of 20 RPs used the RR at least once (Adoption = 95%). Across the three programs, the implementation rate = 67%.

CONCLUSION: The tailored RRs led to moderate reach, high adoption, and moderate-to-high implementation rate, suggesting that RPs found the tool useful and were willing to explore its potential benefits.

IMPACT: Person-centered data visualization tools can be adopted into clinical practice. A future study should examine whether they enhance communication of assessment results and foster better clinical reasoning.

References

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American journal of public health, 89(9), 1322-1327.

American Institutes for Research. (2017). Principles for making health care measurement patient-centered. Retrieved from https://aircpce.org/sites/default/files/PCM%20Principles_April182017_FINAL.pdf

Weaver, J., Mueller, C., McGuire, A., Van Der Wees, P., Davidson, L., Papadimitriou, C., & Mallinson, T. (2022). Translating the Coma Recovery Scale-Revised into clinical practice using person-centered measurement principles. Archives of Physical Medicine and Rehabilitation, 103(12), e68. https://doi.org/10.1016/j.apmr.2022.08.604

Weaver, J. A., Cogan, A. M., O’Brien, K. A., Hansen, P., Giacino, J. T., Whyte, J., Bender Pape, T., van der Wees, P., & Mallinson, T. (2022). Determining the hierarchy of Coma Recovery Scale-Revised Rating Scale categories and alignment with aspen consensus criteria for patients with Brain Injury: A Rasch analysis. Journal of Neurotrauma, 39(19-20), 1417–1428. https://doi.org/10.1089/neu.2022.0095