AN APPLICATION OF KNOWLEDGE TRANSLATION IN THE TREATMENT OF THE PARETIC UPPER EXTREMITY POSTSTROKE IN AN INPATIENT REHABILITATION SETTING. Mary B. Browne* Rehabilitation Institute of Morristown Memorial Hospital, Morristown, NJ UNIQUE: Although research in rehabilitation is increasing, there remain barriers to research being readily translated into practice. This project provided a mechanism for explicit translation of a recent systematic review of interventions for the upper extremity following stroke. PURPOSE: The purpose of the project was to inform clinicians of the current state of research findings and to provide those clinicians with an easily applied decision algorithm to guide treatment planning. FOUNDATION: Patient management is thought to be enhanced in terms of efficiency and effectivenss when based on interventions shown to be effective through high quality research. In February 2003, Susan Barreca, Dip PT, BA, presented the treatment recommendations of the 2001 Consensus Panel on the Management of the Post- stroke Arm and Hand. These recommendations were based on a series of meta-analyses when the research was available and where not, on a high level of consensus (8 of 9)of the nine expert clincians on the panel. The treatment principles that emerged from this critical review were: 1. When a low level of upper extremity motor recovery (motion only in synergistic patterns) is expected following stroke, compensatory interventions should be used for function with emphasis on maintaining a mobile, comfortable upper extremity. 2. When a higher level of motor recovery is anticipated (ability to move out of synergistic patterns), every effort should be made to assist the person to regain functional use of the arm and hand. 3. Shoulder/arm pain should be prevented; when that is not possible, effective interventions should be used to manage pain. The Consensus exercise used the upper extremity assessment of the Chedoke-McMaster Stroke Assessment to classify recovery. Using this 7-point scale, motor recovery anticipated to be 3 or below would fit the low level classification, and 4 or above the higher level. The paneal presented their recommendations for best practice based on the best available evidence and, where that was not available, expert opinion supported by scientific rationale. DESCRIPTION: This project sought to bring these recommendations to busy clinicians in an easily managed way. To that end, six actions were understaken. First, through a series of four one-hour inservices, the Occupational Therapists in an inpatient rehabilitation setting were familiarized with the reommendations. Second, they were trained in the use of the Chedoke-McMaster upper extremity assessment. Third, a table of prediction outcomes was devised for each level of motor recovery and time since stroke. Fourth, a decision algorithm was devised for quick reference for appropriate intervetions for low (1-3)and higher levels (4-7) of predicted motor recovery, shoulder/arm pain management, shoulder subluxation, and upper extremity swelling. Fifth, information technology support developed a forced documentation for admission and discharge assessment scores for all stroke patients with hemiplegia or hemiparesis. Fifth, an audit process was developed. OBSERVATIONS: The Occupational Therapists became competent to apply the Chedoke-McMaster upper extremity assessment tool quite rapidly. Two outcomes were then anticipated. Of those patients predicted to achieve a motor recovery of 4 or above, 75% of them would do so by discharge. Of those patients who entered inpatient rehabilitation without shoulder pain, 90% would remain pain free in the upper extremity. The major problem with the audited outcomes was that of incomplete data (625% complete). Of those for whom complete data was available, the outcomes were met. CONCLUSIONS: With an investment of four hours of inservicing, the occupational therapists had a method of classifying motor recovery in the upper extremity and making a prediction for further recovery based on that and time since stroke. The table of formulas made this quick. The decision algorithm made recommended interventions readily referrable. It is important to get emerging research findings and recommendations to busy clinicians rapidly and effectively. FUNDING SOURCE: none KEYWORDS: stroke, upper extremity, interventions, knowledge translation Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.