ontario stroke network · each region has a regional stroke centre and many have district stroke...

June 2012

Ontario Stroke Network Research Program Impact Assessment

3rd Annual Report

Published by the Ontario Stroke Network

For more information contact: Ontario Stroke Network

Email: [email protected]

www.ontariostrokenetwork.ca

A Message from the Chair, OSN Board and OSN Executive Director

This report represents the third formal evaluation of the Ontario Stroke Network (OSN) Research Program. The purpose of the 3rd Annual Research Impact Assessment Report (formerly titled the OSS Research Program Evaluation Report) is to inform partners and stakeholders about the ongoing activities, impacts and successes of OSN funded stroke research in the province. The first formal evaluation of the program was undertaken in 2009, representing an assessment of the previous three years of funding for fiscal years (FY) 2006/07, 2007/08 and 2008/09. The recommendations from that report outlined a framework for ongoing assessment and reporting which were used to guide the evaluations undertaken in the second and current installment of the OSN Research Program evaluation. This report will highlight the FY 2010/11 Research Program Inputs and Activities, FY 2009/10 Near- Term Outputs and FY 2007/08 and 2004/05 Long-Term Impacts as reported by researchers and the OSS community. In addition a number of successful projects identified by the OSS community as having significant achievements on care and service delivery are presented as case studies. Moving forward and in alignment with the OSN mandate to provide provincial leadership and planning for the Ontario Stroke System (OSS) the OSN has recently announced the development of the following: 2011-16 OSN Strategic Plan and the OSN Research Grant Administration Policy which includes the OSN Managed Research Cycle1 framework. These documents were created with input and contributions from the OSN Board, OSN Research Committee, OSS Team, researchers and stakeholders and are available on the OSN website: www.ontariostrokenetwork.ca. The OSN continues to be successful in catalyzing system-wide improvements in stroke prevention, care and treatment, as evidenced by decreasing incidence of stroke and improvements in clinical outcomes. The implementation of these OSN research policies and frameworks combined with the annual assessment of research impacts will ensure continued awareness and engagement of OSS stakeholders in the evaluation process and increased participation in knowledge sharing, practice changes and sustained improvements over time.

Malcolm Moffat Chair, OSN Board

Chris O’Callaghan OSN Executive Director

1 Adapted from the Heart and Stroke Foundation of Canada (HSFC)

http://www.ontariostrokenetwork.ca/pdf/Ontario_Stroke_Network_2011-2016_Strategic_Plan_Report_Final_Sept_9_2011.pdf

http://www.ontariostrokenetwork.ca/pdf/Ontario_Stroke_Network_2011-2016_Strategic_Plan_Report_Final_Sept_9_2011.pdf

http://www.ontariostrokenetwork.ca/pdf/OSN_Research_Grant_Administration_Policy_September_23_2011_Final_3pm.pdf

http://www.ontariostrokenetwork.ca/pdf/Ontario_Stroke_Network_Managed_Research_Cycle.pdf

http://www.ontariostrokenetwork.ca/pdf/Ontario_Stroke_Network_Managed_Research_Cycle.pdf

http://www.ontariostrokenetwork.ca/

About the Ontario Stroke Network

Given a mandate to provide provincial leadership and planning for the Ontario Stroke System (OSS)2, the Ontario

Stroke Network (OSN) was established and incorporated in 2008 as a non-profit organization funded by the

Ministry of Health and Long-Term Care and Ministry of Health Promotion and Sport. The OSN is an innovative,

collaborative organization committed to enhancing stroke prevention and care for all Ontarians. With its vision

of Fewer Strokes, Better Outcomes, the Ontario Stroke Network (OSN) provides provincial leadership and

planning for the Ontario Stroke System (OSS) by measuring performance, partnering to achieve best practices,

and supporting innovations for stroke prevention, care, recovery and reintegration. The OSN delivers on its

mission by establishing province-wide goals and initiatives to implement best practices across the stroke

continuum, evaluating and reporting on the progress of the OSS, and administering the Ontario Stroke Network

research and knowledge translation program.

Vision

Fewer strokes. Better outcomes.

Mission

The Ontario Stroke Network provides provincial leadership and planning for the Ontario Stroke System by

measuring performance, partnering to achieve best practices, and creating innovations for stroke prevention,

care, recovery and reintegration.

Strategic Directions

In February 2011 the OSN identified two Strategic Directions to guide its work from 2011-2016. These Strategic Directions will serve as the framework for OSN’s initiatives.

Credible leader, strategic partner and effective advocate for fewer strokes and better outcomes

Catalyst to drive for excellence in stroke care and vascular health

2 The Ontario Stroke System is a client-centred collaboration of 11 regional stroke networks supporting Ontario’s 14 Local Health Integration

Networks. Each region has a regional stroke centre and many have district stroke centre(s) each stroke network is a collaborative partnership of health care organizations and providers that span the care continuum from prevention to community re-engagement.

http://www.ontariostrokenetwork.ca/

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Table of Contents

Executive Summary 5

Full Report - 3rd Annual OSN Research Program Impact Assessment 9

Research Program Inputs (FY 2010/11) 9

Research Program Activities (FY 2010/11) 12

Near-Term Outputs (FY 2009/10) and Long-Term Impacts (FY 2007/08 and FY 2004/05) 14

Research Impact Assessment Summary as reported by OSN Regional Teams 21

High Impact Case Studies as reported by OSN Regional Teams (FYs 2006/07 to 2009/10) 24

Appendix A – OSN Managed Research Cycle 26

Appendix B – Recent Publications 27

Appendix C – 2009/10 Near-Term Outputs (Objectives, New Knowledge/Tools, Implications) 30

Appendix D – High Impact Case Studies (New Knowledge, Impacts and Success Factors) 35

Appendix E – History of OSN Funded Research Projects 40

Appendix F – 2010 OSN Research Board and OSN Research Committee Membership 46

Table 1 - Funded and Unfunded Proposal Summaries 10

Table 2 - Alignment of Projects along the Continuum of Care 12

Table 3 - Summary of Near Term Outputs from Research Projects (FY 2009/11) 14

Table 4 - Summary of Impacts- Projects Funded in FY 2007/08 17

Table 5 - Summary of Impacts- Projects Funded in FY 2004/05 19

Table 6 - Long-Term Impacts Achieved identified in the OSN Regional Team Survey 21

Table 7 - High Impact Case Studies Identified by OSN Regional Team Survey 24

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Executive Summary

The 3rd Annual OSN Research Impact Assessment provides a comprehensive review of activities, new knowledge

and tools, and outcomes resulting from OSN Research Program funding. The information is used by partners and

stakeholders to monitor the impacts of the research program and to provide opportunities to facilitate

knowledge translation and plan for future areas of research focus3.

The Executive Summary highlights key Findings and suggested next steps in Looking Ahead resulting from the analysis of:

FY 2010/11 Research Program Inputs4 and Activities5,

FY 2009/10 Near- Term Outputs and FY 2007/08 and 2004/05 Long-Term Impacts 6reported by researchers and Research Assessment Impacts7 and;

Select High Impact Case Studies8 identified by the OSS community.

Findings

RESEARCH PROGRAM INPUTS

The FY 2010/11 funding year represented the highest amount of leveraged investment through external agencies9. The total project funding supported by the OSN including leveraged funding increased by 148% over the previous year from $945,536 in FY 2009/10 to $2,345,313 in FY 2010/11.

The total number of Principal Investigators (PIs) and Co-Investigators (Co-Is) supported by the OSN increased

by 69 % over the previous year from 43 in FY 2009/10 to 73 in FY 2010/11.

As a result of the competitive nature of the OSN Research Program and the research funds available, the

average number of projects submitted that were not funded over the FY 2010/11 remained consistent from

previous years at about 50% of the total number of applications received.

3 The OSN Managed Research Cycle (see Appendix A) provides a framework to support ongoing and continuous collaboration and knowledge exchange

between researchers and knowledge users. The overall aim of the framework is to determine and inform highly relevant research that has potential for application in care delivery and policy areas. 4 Inputs are the fuel to the OSN Research Program in any given evaluation period, are expected to generate downstream benefits, and are the basis for

assessing OSN research program investments 5 Research Program Activities are the actual research projects underway in a given evaluation period that translate research inputs into near-and long-

term benefits. 6 Near-Term Outputs are the immediate outcomes emerging from funded research resulting in new knowledge (e.g. key findings from individual research

projects) and/or new tools (e.g. successful implementation of procedures or processes). Long-Term Impacts are recognized sustained levels of impact such as changes in clinical practice, training changes, citations of research and impact on overall health/economic status. The information analyzed in this section was collected from researchers and detailed in the Researcher Follow-Up Surveys 7 Using the OSN Managed Research Cycle (see Appendix A), the Ontario Stroke Regions were surveyed to assess knowledge of outcomes and impacts of

OSN funded research projects on the delivery of stroke care, recovery, rehabilitation and reintegration in the province 8 Several case studies of OSN funded projects (FYS 2006/07 – 2009/10) were identified as a result of the OSN Regional Team Survey as having high impact

in influencing practice at all stages across the continuum of care. 9 Leveraged funding is used to generate further research support from other grants or sources of income.

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RESEARCH PROGRAM ACTIVITIES

The OSN supports research that is stroke related, hypothesis driven and has generalizable and/or transferable outcomes and aligns with CIHR Themes 2, 3, 410.

The OSN supports research at all stages across the continuum of care. Although many projects impact multiple stages of the continuum of care the four year average continues to show a greater number of research projects supporting rehabilitation and community re-integration fields.

The OSN Research Program remains responsive across health research themes and continues to fill a critical gap in projects which may receive less emphasis from other funding agencies.

NEAR –TERM OUTPUTS and LONG-TERM IMPACTS AS REPORTED BY RESEARCHERS

Researchers continue to actively engage in knowledge translation and research dissemination activities such

as presentations and publications. Between January 2011 and February 2012, OSN researchers contributed

to the advancement of knowledge in stroke care:

o 35 publications were reported as a result of OSN research funding (see Appendix B)

o 17 presentations at various Ontario and International stroke forums (e.g. American Stroke Conference,

World Stroke Congress, Stroke Collaborative)

o 25 OSN and regional stroke network posters and 10 platform presentations were provided at the 2011

Canadian Stroke Congress.

RESEARCH IMPACT ASSESSMENT AS REPORTED BY OSN REGIONAL TEAM SURVEYS BASED ON THEMES

For the first time, and in accordance with the OSN research evaluation framework, the OSN Regional Teams were surveyed to examine the correlation (if any) between regional distribution of funded projects and levels of awareness and impact on the delivery of stroke prevention and care as a result of OSN funded research. Twelve responses were received (2 Districts, 7 Regions, and 3 combined). The key findings from each category (awareness, changes in clinical practice, knowledge sharing, sustainability and overall relevance) were:

100% of survey responses indicated knowledge of strategies to increase awareness of OSN funded research activities and findings among stakeholders such as physicians, nurses, allied health professionals, and patients.

58% of survey respondents indicated that they implemented changes in practice as a result of OSN funded research and 25% of survey respondents said that they had initiated change in practice.

10 CIHR Theme 2: research with the goal of improving the diagnosis, and treatment (including rehabilitation and palliation) of disease and injury and improving the health and quality of life of individuals as they pass through normal life stages. Theme 3: research with the goal of improving efficiency and effectiveness of health professionals and the health care system, through changes to practice and policy. Theme 4: research with the goal of improving the health of the Canadian population, or of a defined sub-population through a better understanding of the ways in which social, cultural, environmental, occupational and economic factors determine health status.

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67% of respondents participated in sharing of OSN research findings and activities with other regions in the province (either as a provider or recipient of knowledge exchange).

50% of respondents indicated success in sustainability of changes in practice that were implemented in their district/region.

67% of respondents indicated medium to high recognition of value of OSN funded research in an overall relevance category.

OSN Regional Team awareness of outcomes and impacts will be evaluated annually in order to ensure ongoing improvement of dissemination activities enhancing long-term impacts of the OSN research program. HIGH IMPACT CASE STUDIES

Four case studies of OSN funded projects (FYS 2006/07 – 2009/10) were identified as a result of the OSN Regional Team Survey as having high impact in positively influencing practice at all stages across the continuum of care. Researchers participating in the case study reviews were interviewed and invited to describe new knowledge or tools created, discuss the impact of the research findings across the continuum of care, and identify success factors. Key findings from these discussions are highlighted below:

All high impact case study researchers acknowledged that OSN funding provided either seed funding for pilot studies or ongoing funding to build on the recommendations from earlier studies.

All researchers indicated strong collaborations and partnerships as a key element contributing to success.

Early engagement of researchers and regional stroke network stakeholders to facilitate project completion was strongly recommended. OSN researchers and staff are extremely motivated and willing to offer their knowledge.

Recommendation to OSN to consider developing a mentorship program. Experienced researchers could help front line staff/clinicians/professionals with strong research ideas to develop solid proposals, identify appropriate methodologies, and create supportive partnerships.

Looking Ahead

Research funds be targeted to directed research questions identified by the Stroke Evaluation Quality Committee (SEQC) and Knowledge Users and through collaborations with agencies such as Health Quality Ontario (HQO).

The OSN Research Program, using the OSN Managed Research Cycle, continue to facilitate the direct translation of the research investment into improvements in patient care.

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Based on the results of the research evaluations conducted to date, future recommendations/directions should include:

o The OSN Research Committee should: continue to oversee the implementation of the OSN Managed Research Cycle consider inviting additional partners, including non-profit agencies and community hospitals

and academic centres, to complete OSN Regional Stroke Surveys and consult with the regional stroke teams and researcher community to identify strategies to enhance knowledge exchange of research findings.

o The OSN should: encourage collaborations (between regional stroke networks and researchers) that

strengthen applicability and generalizability of research results in varied environments support knowledge exchange between regional stroke networks and researchers and build

research capacity as a grant application requirement consider including a section in the Call for Proposals asking researchers to outline a plan for

project sustainability report on the impact of the Applied Health Research Questions (AHRQ) Directed Priorities

and include this as a new metric in the Research Impact Assessment.

o The OSN will continue collaboration with the Ontario Regional Education Group (OREG) to

explore opportunities and/or collaborations with agencies to support development and mentorship of new researchers

develop a monitoring mechanism linking knowledge translation initiatives to facilitate uptake of research knowledge into practice

facilitate and support Regional Stroke Teams to explore opportunities to actively engage researchers in local outreach and making presentations to Regional Stroke Teams.

In summary, the results of the research program impact assessment provided in this report demonstrate that the OSN Research Program continues to influence improvements in stroke prevention, care and treatment. The OSN will continue to apply the research impact assessment framework and results to monitor the impacts of the research program over time. The evaluation process that is in place will provide guidance for the identification of future OSN strategic directions, build capacity in stroke research and provide opportunities to facilitate knowledge translation.

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Full Report

3rd Annual OSN Research Program Impact Assessment

The 3rd Annual OSN Research Impact Assessment (previously referred to as the Ontario Stroke System Research

Program Evaluation) provides a comprehensive review of activities, new knowledge and tools, and outcomes

resulting from OSN Research Program funding. The information is used by partners and stakeholders to monitor

the impacts of the research program and to provide opportunities to facilitate knowledge translation and plan

for future areas of research focus.

The overall purpose of this report is to examine the activities, outcomes and impacts of the OSN Research

Program by:

1. Highlighting Research Program Inputs which include the FY 2010/11 OSN research investment vs. the amount of OSN funding requested by the stroke community.

2. Reporting on OSN funded Research Activities from FY 2007- 2011 that demonstrate alignment along the continuum of care and with OSN priorities.

3. Illustrating Near-Term Outputs from projects funded in FY 2009/10 and Long-Term Impacts from research projects funded in FY 2007/08 and 2004/05 reported by OSN funded researchers.

4. Completing an Assessment of Research Impact of previously funded research projects and presenting Case Studies of successful OSN funded projects (FY 2006/07 -2009/10) that have demonstrated lasting impact as identified by the OSS community.

RESEARCH PROGRAM INPUTS

This section will highlight Research Program Inputs for FY 2010/11.

Inputs are the fuel to the OSN Research Program in any given evaluation period. Inputs are expected to generate

downstream benefits, and are the basis for assessing OSN research program investments. The scope of inputs

analyzed includes: number of projects funded, OSN funding awarded and successfully leveraged, and summary

of participating investigators and teams, institutions and regions.

In FY 2010/11, the OSN funded 12 research projects from a total of 23 eligible proposals submitted from across

Ontario.

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Table 1: Funded and Unfunded Proposals

Funded Proposals:

OSN Research Program Inputs –

Four Year Funding Summary

07/08 08/09 09/10 10/11 4-Year

Average

OSN funding disbursed $1,006,762 $932,788 $839,276 $888,958 $916,946

Additional funding leveraged* $481,053 $45,000 $106,260 $1,456,355 $522,167

Total funding for research projects $1,487,815 $977,788 $945,536 $2,345,313 $1,439,113

Funded Proposals: OSN Research Program Inputs –

Four Year Project Summary

07/08 08/09 09/10 10/11 4-Year

Average

Number of projects 15 11 11 12 12.25

Number of OSN regions representing

the host institution 7 8 6 5 7

Number of projects engaging multiple

OSN regions n/a n/a 7 7 n/a

Number of PIs & Co-Investigators

involved ** 38 62 43 73 54

Number of students funded 3 0 7 4 3.5

Number of other personnel funded 33 49 28 32 35.5

Unfunded Applications Summary of OSN Requested Funding

07/08 08/09 09/10 10/11 4-Year

Average

Number of unfunded applications 6 23 10 11 12.5 Number of sponsoring organizations 6 19 10 11 11.5

Number of OSN regions 5 10 9 7 7.8 OSN funding requested $738,912 $2,379,292 $721,080 $783,727 $1,155,753

* Reported inconsistently prior to 2008/09

** Salary support for these individuals is not eligible for OSN funding

Summary of Findings

Analysis and interpretation of data detailed in Table 1 is presented below.

The FY 2010/11 funding year represented the highest amount of leveraged investment through external agencies. The total project funding supported by the OSN including leveraged funding increased by 148% over the previous year from $945,536 in FY 2009/10 to $2,345,313 in FY 2010/11.

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Leveraged investment was secured from partners such as the Canadian Stroke Network (CSN), Canadian Institutes for Health Research (CIHR), Auxilium Foundation, Ministry of Health and Long-Term Care (MOHLTC), research institutions and stroke regions. In-kind support was also reported from the March of Dimes and the Toronto Rehabilitation Institute in FY 2010/11.

The total number of Principal Investigators (PIs) and Co-Investigators (Co-Is) supported by the OSN increased

by 69 % over the previous year from 43 in FY 2009/10 to 73 in FY 2010/11 demonstrating that OSN

investments in research contribute significantly to developing research skills, building linkages and

partnerships, and creating environments that support innovative stroke prevention, care, recovery and

reintegration research.

As a result of the competitive nature of the OSN Research Program and the research funds available the average number of projects submitted that were not funded over the FY 2010/11 remains consistent from previous years at about 50% of the total number of applications received.

The total project funding supported by the OSN including leveraged funding through external agencies increased by 148% over the previous year from $945,536 in FY 2009/10 to $2,345,313 in FY 2010/11.

o Securing leveraged funds allows researchers to expand their projects/programs of research, build capacity, and find effective ways to translate new knowledge and research findings to wider audiences.

Looking ahead

The OSN will pursue opportunities to offer targeted Calls for Proposals, jointly funded and sponsored in collaboration with other health care agencies and organizations, with similar mandates to affect health systems change.

Using the grant application requirements, the OSN will continue to encourage Regional collaboration in research to facilitate and strengthen applicability and generalizability of research results in varied environments, support knowledge exchange and build research capacity.

The OSN Research Committee will expand the reach of the current evaluation process to assessments and analysis of all partners, including non-profit agencies and community hospitals and academic centres as part of the OSN Research Impact Analysis.

“Receiving OSN funding was critical to the success of my research project. The OSN is responsive to applied

research issues and addressing current priorities in a timely way. The efficient management of the grants

program with relatively quick decision turnaround time allows for effective research project and program

planning.”

Jill Cameron, University of Toronto, OSN Researcher

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RESEARCH PROGRAM ACTIVITIES

This section will illustrate OSN funded Research Program Activities from FY 2007/08 -2010/11 that demonstrate alignment along the continuum of care and with OSN Research Priorities. Research Program Activities are the actual research projects underway in a given evaluation period that translate research inputs into near-and long- term benefits.

Researchers are encouraged to submit proposals for projects at all stages of the OSN continuum of care. Analysis of the alignment of projects along the OSN continuum of care is the primary metric monitored longitudinally to better understand Research Program Activities funding by the OSN Research Program. Table 2: Alignment of Projects along the Continuum of Care

Funded Proposals 07/08 08/09 09/10 10/11 4-Year

Total

4-Year

Average

Prevention – Primary 1 2 4 4 11 2.75

Prevention – Secondary 9 2 4 5 20 5

Acute care 4 2 3 3 12 3

Long-term care 7 1 3 5 16 4

Rehabilitation 7 8 6 6 27 6.75

Community re-integration 10 6 5 8 29 7.25

Note: A single project may impact multiple stages of the continuum of care therefore total project numbers will

not necessarily match

Summary of Findings

A discussion of the data presented in Table 2 is detailed below.

The OSN supports research that is stroke related, hypothesis driven and has generalizable and/or transferable outcomes and align with CIHR Themes 2, 3, 4.11 In FY 2010/11 the OSN Research Program’s priority was to fund research that:

o Addresses OSS Strategic Directions o Supports the MOHLTC’s Strategic Directions and has linkages to MOHLTC Health Priorities and

Local Health Integrated Networks (LHINs) o Focuses on prevention, care, and recovery or community re-integration.

11 CIHR Theme 2: research with the goal of improving the diagnosis, and treatment (including rehabilitation and palliation) of disease and injury and improving the health and quality of life of individuals as they pass through normal life stages. Theme 3: research with the goal of improving efficiency and effectiveness of health professionals and the health care system, through changes to practice and policy. Theme 4: research with the goal of improving the health of the Canadian population, or of a defined sub-population through a better understanding of the ways in which social, cultural, environmental, occupational and economic factors determine health status.

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The OSN supports research at all stages across the continuum of care. The four year average continues to show a greater number of research projects supporting rehabilitation and community re-integration fields.

The OSN Research Program remains responsive across health research themes and continues to fill a critical gap in projects which may receive less emphasis from other funding agencies.

Looking ahead

Following the Ontario Ministry of Health and Long-Term Care’s Applied Health Research Question (AHRQ)12 principles and in accordance with the OSN Research Grant Administration Policy and detailed in the Managed Research Cycle, at least 25% of the research funds will be targeted to directed research questions as identified by the Stroke Evaluation Quality Committee (SEQC) and Knowledge Users and through collaborations with agencies such as Health Quality Ontario (HQO).

Reporting on the impact of the AHRQ Directed Priorities will become a new metric in future years.

“We recognized a gap in teaching health care providers (HCP) working in LTC and community settings the

knowledge and skills required to care for stroke survivors. Non-regulated staff were thirsty for continuing

education opportunities. The OSN research funding covered the costs for staff to design, deliver, and evaluate

the project over a 2-year period. This successful program is now offered at no cost to non-regulated HPCs in the

Southeast Ontario Stroke Network.”

Sue Saulnier, Education Coordinator, Stroke Network of Southeastern Ontario, OSN Researcher

Kathleen Kennedy, Professor, Nursing, School of Health Sciences St. Lawrence College, Kingston Campus General

Hospital, OSN Researcher

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An AHRQ is a question posed by a health system Knowledge User in order to request research evidence that can be applied to improve or benefit the

Ontario health system.

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NEAR-TERM OUTPUTS AND LONG-TERM IMPACTS AS REPORTED BY RESEARCHERS

This section highlights Near-Term Outputs, or immediate outcomes, emerging from FY 2009/10 OSN funded

research. Examples of new knowledge (e.g. key findings from individual research projects) and/or new tools

(e.g. successful implementation of procedures or processes) are presented. The data for this section was

obtained from the Final Project Report forms submitted by researchers for each completed project.

This section also presents examples of Long-Term Impacts from research projects funded in FY 2007/08 and

2004/05 which reveal sustained levels of impact such as changes in clinical practice, training changes, citations

of research and impact on overall health/economic status. The information analyzed in this section was

collected from researchers and detailed in the Researcher Follow-Up Surveys.

NEAR-TERM OUTPUTS

In the following table a summary of completed FY 2009/10 OSN-funded research projects are presented highlighting new knowledge or tools created and implications. (See Appendix C for a fuller description of project objectives and implications). Table 3: Summary of Near Term Outputs from Research Projects (FY 2009/11)

PI/ Sponsoring Organization

Project Title New Knowledge or New Tool: Near Term Outputs from Research Projects (FY 2009/11)

Dina Brooks University of Toronto Nancy Salbach University of Toronto

Investigating the relationships between clinical and laboratory-based measures of exercise capacity and measures of physical activity in daily life in individuals post stroke

Contribution to existing literature describing the cardiorespiratory responses observed in people with stroke completing the6MWT.

Preliminary findings from the current study suggest that aerobic capacity is challenged during the 6MWT, and 6-minute walk distance (6MWD) relates to daily physical activity.

Mary Egan University of Ottawa

Measuring engagement in valued activities and its health benefits among stroke survivors living in long-term care facilities

Stroke survivors discharged to retirement homes may be at particular risk for lowered participation in valued activities, which may play an important role in depression.

Personal Projects Analysis provides a useful tool for identifying personally valued activities which could be used to form participation goals. With practice, individuals with cognitive and language deficits can use this tool.

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Ruth Hall Dr. Moira Kapral Institute for Clinical Evaluative Sciences

Evaluating the Quality of Secondary Prevention Clinic Data in Ontario

Linkable SPC database was created that includes detailed description of database variables.

New SPC web-based data collection tool was created with built-in data quality features including; a revised case record form (minimum dataset); data dictionary, and revised triage algorithm.

Robert Teasell St. Joseph’s Health Care London; Lawson Health Research Institute and University of Western Ontario

An Economic Model for Stroke Rehabilitation in Ontario: Mapping Resource Availability and Patient Needs

Survey results indicate that current rehabilitation resources are insufficient and modeling results suggest that patients are not able to access the services they need.

Economic estimates suggest the need for investment in the rehabilitation sector.

Results suggest that current rehabilitation resources in Ontario are insufficient to meet the annual need for services.

Gail MacKenzie Hamilton Health Sciences

Tailored Interventions to Improve Hypertension Management After Stroke or TIA Study - Phase II (TIMS II)

Telephone follow-up was valued by the intervention participants and did not take a major time commitment from the Secondary Prevention Clinic (SPC) nurses.

The SPC nurses gained insight and understanding of the challenges clients face in making lifestyle changes, and were able to identify helpful strategies.

Most participants indicated they made some lifestyle changes during the 6 month follow-up period.

Preliminary analysis for 55 participants demonstrated both intervention (INT) and usual care (UC) participants achieved BP reductions.

Krystyna Skrabka South East Toronto Stroke Network

Effect of the Implementation of an Inpatient Code Stroke Protocol (ICSP)on Outcomes and Staff Knowledge

Implementation of the ICSP resulted in improvement in the process indicators related to assessment and treatment of hyper-acute stroke.

o 24% reduction in time from initial physician assessment (IPA) to CT scan; 72% reduction in time from last seen normal (LSN) to IPA; 59% reduction in time from LSN to CT scan; 13% reduction in post stroke complications.

The percentage of stroke in the surgical populations decreased by 17%, the number of non-surgical strokes likely remained the same, and recognition of stroke symptoms by hospital staff increased.

In the majority of cases, code stroke was activated either by the medical resident or staff physicians, however, in 6% and 3% of cases a code stroke was activated by a Registered

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Nurse (RN) or Nurse Practitioner (NP) respectively.

An ICSP e-learning package has been developed and will be used in staff and resident orientation as well as a knowledge refresher for staff which will lead to a positive change in practice in patient care.

Bruce Minore Centre for Rural and Northern Health Research

Teach Our Children: Stroke Awareness for Aboriginal Youth

The findings revealed considerable variability in Aboriginal youth’s knowledge about stroke.

Development of a culturally and age-appropriate DVD stroke education tool for Aboriginal youth based on interviews with health and education professionals and discussion groups with youth and featuring Anishnawbe youth teaching their peers about stroke.

Based on feedback from the NWORSN Aboriginal Advisory Committee and people in participating First Nations, the DVD will be used extensively in the communities, their schools and health care organizations.

The DVD will be available for use by health and education professionals to heighten the awareness of signs and symptoms of stroke.

Dr. Gustavo Saposnik St. Michael's Hospital

S.O.S. Stroke Care - Evaluating gaps along the continuum in stroke care

Preliminary findings indicate that 8.6% of all ischemic stroke patients have not received a prescription for either antihypertensives or lipid lowering agents at hospital discharge.

Some ischemic stroke patients (31.3%) have a history of prior use of either antihypertensives or lipid lowering agents; the majority of patients (68.7%) have no prior history of taking either of these preventive therapies.

45.5% of those with no prior history for taking antihypertensives or lipid lowering agents were provided with a prescription for at least one of these therapies at discharge, while 89.8% of patients having a prior history of using at least one of these therapies received a prescription at discharge.

Long-Term Impacts from FY 2007/08 and 2004/05 OSN Funded Research Projects

The following table provides a summary of OSN-funded research projects from FY 2007/08 and one project funded in FY 2004/05 and includes a brief description of long-term impacts achieved such as changes in clinical practice, training changes, citations of research and impact on overall health/ economic status.

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These results are not a comprehensive list of all FY 2007/08 and 2004/05 OSN funded research projects, but rather represent a sample of long-term impacts achieved as reported by project researchers. Table 4: Summary of Impacts- Projects Funded in FY 2007/08 Key Findings from Two-Year Follow Up Survey


Project Title

New Knowledge or New Tool: Long Term Impacts from Research Projects (FY 2007/08)

Sandra Ireland McMaster University

Tailored Interventions to Improve Management After Stroke or TIA Pilot Study (TIMS)

Changes in Clinical Practice

Implementation of Screening for cognition and medication

self-efficacy and adherence for all patients attending the

Regional Stroke Prevention Clinic.

Citations of Research

Follow-on RCT at 3 Ontario Stroke Prevention Clinics (TIMS II)

Presentation of TIMS II results at the 2011 Canadian Stroke Congress (poster)

Aura Kagan Aphasia Institute

Communicative Access Measures for Health Systems: Development and Evaluation

Impact on Overall Health/ Economic Status Anticipated contribution to compliance with current accessibility legislation in Ontario as well as contributions to effectiveness of stroke care and patient/client satisfaction New tool Online product is in the process of being developed based on this project. The product will be made available in Ontario at no charge.


Aboriginal Stroke Educational Strategy

Clinical Uptake

DVD disseminated to all Regional Stroke Offices in Ontario for educational and outreach purposes (50 copies each)

DVDs distributed, on request, to educational institutions across Canada (e.g. Northern Ontario School of Medicine and University of Northern British Columbia include DVD in clinical teaching resources)

Additional requests for DVDs from health care organizations in Alberta, Saskatchewan and New Brunswick

Impact on Overall Health/ Economic Status DVD used in First Nation community as a teaching tool as evidenced by a youth citing stroke information from the DVD after father had stroke.

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Project Title


Esmé French Thunder Bay Regional Health Sciences Centre Regional Stroke Program

Evaluation of the impact of an eight-week, stroke-specific exercise programme developed by physiotherapists and delivered in the community by trained fitness facilitators


Keep Moving with Stroke program in Thunder Bay (Thunder Bay – 12 sessions, 131 registrations, delivered since January 2009)

171 DVD’s disseminated to clinicians in 49 cities in Canada, USA and Australia

Tools

Creation of new DVD training resource

Inclusion in “Guidelines for Community Based Exercise Programs for People with Stroke ( 2010)”

Citations of Research Included in “Guidelines for Community Based Exercise Programs for People with Stroke ( 2010)” Impact on Overall Health/ Economic Status

Stroke lifestyle risk factor management and improved health with access to fitness post-discharge from rehabilitation for people with stroke contributes to reduction in stroke recurrence.

Community-based fitness class for people with stroke “Keep Moving with Stroke” continues to run in Thunder Bay: 12 sessions, 131 registrations (since April 2009).

Jill Cameron University of Toronto

The Weekend Home Visit Program during Impatient Rehabilitation: How can we Optimize the Benefits to Stroke Survivors and Family Caregivers?

Health care professionals identified safety in the home as a primary concern and recognized a need to prepare patient and family for the transition from health care setting to home. The health care team, caregivers and stroke patients viewed the Weekend Pass (WP) program as a valuable way to facilitate transition home but felt improvements to program delivery would enhance the experience. Clinical Uptake Enhancement of/ modification to WP program at the Toronto Rehabilitation Institute. Training Changes

Weekend pass included in Timing it Right Stroke Family Support Program currently being evaluated in multi-site RCT funded by Heart and Stroke Foundation.

Possible changes to practice at local rehabilitation facilities through co-investigator involvement and presentation at provincial stroke meetings/workshops

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Project Title


Rebecca Fleck Central South

Regional Stroke

Network

Strategic Processes for Implementing Stroke Best Practices in Long Term Care Homes in Central South Stroke Region

New Tool

Partnership with the RNAO to post the stroke modules on the RNAO tool kit website.

Partnership with the Regional Geriatric Program to post the stroke best practice modules on their website.

Impact on Overall Health/ Economic Status

Education Modules have increased awareness of LTC staff involved in the research project to identify the signs and symptoms of stroke and utilize best practice strategies with their residents who have had stroke.

Table 5: Summary of Impacts- Projects Funded in FY 2004/05 Key Findings from Five-Year Post Project Completion


Project Title New Knowledge or New Tool: Long Term Impacts from Research Projects (FY 2004/05)

Dr. Frank Silver Dr. Moira Kapral Dr. Gustavo Saposnik On behalf of the Canadian Stroke Network

The Canadian Stroke Network Registry Project

Tools iScore (Ischemic Stroke risk score) is a Web/iPhone Application that predicts clinical response to tPA and risk of intracerebral hemorrhage. Citations of research In Feb 2012 there was an AHA Joint release, presentation and expedited publication of the research team’s work “The iScore predicts effectiveness of thrombolytic therapy for ischemic stroke”. Impact on Overall Health/ Economic Status The present manuscript shows that the iScore predicts clinical response to tPA and risk of intracerebral hemorrhage. There was an interaction between the iScore and the tPA treatment effect. Together with the researchers’ previous work, the iScore is a single tool that may assist clinicians not only in estimating early and long term mortality, death and disability at discharge, and death and institutionalization at discharge, but also clinical response to tPA and risk of hemorrhagic complications.

http://stroke.ahajournals.org/content/early/2012/02/02/STROKEAHA.111.646265.full.pdf?ijkey=di09tqMOvF1zyFY&keytype=ref



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Summary of Findings

Key findings for data provided in Table 3 are presented below.

Researchers continue to actively engage in knowledge translation and research dissemination activities such

as presentations and publications.

As of December 31, 2011, OSN researchers contributed to the advancement of knowledge in stroke care:

o 35 publications were reported as a result of OSN research funding (see Appendix B).

o 17 presentations at various Ontario and International stroke forums (e.g. American Stroke

Conference, World Stroke Congress, Stroke Collaborative).

o 25 OSN and regional stroke network posters and 10 platform presentations were provided at the

2011 Canadian Stroke Congress.

Looking ahead

Long term impacts were assessed from the Follow Up Survey reports submitted by researchers with

completed projects in FY 2007/08 and one project funded in FY 2004/05. Future Evaluation reports will

include increased number of impact findings from both 2 year and 5 year intervals post project completion

and are a component of current funding agreements.

The OSN Research Committee will consult with the regional stroke teams and researcher community to identify strategies for knowledge exchange from project findings to stroke care providers/organizations.

We were fortunate that our institutions and managers value and support our work. They have allowed us to

continue to go out and deliver the Collaborative Interprofessional Stroke Care Community Re-engagement

Education program.”

Donna Cheung, (Rehab and Community Re-engagement Coordinator), St. Michael’s Hospital, OSN Researcher

Jocelyne McKellar, (Rehab and Community Re-engagement Coordinator), Toronto Western Hospital, OSN

Researcher

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RESEARCH IMPACT ASSESSMENT SUMMARY AS REPORTED BY OSN REGIONAL TEAM SURVEYS

In the Fall 2011, using the OSN Managed Research Cycle (see Appendix A), the Ontario Stroke Regions were

surveyed to assess knowledge of outcomes and impacts of OSN funded research projects on the delivery of

stroke care, recovery, rehabilitation and reintegration in the province. Twelve responses were received including

contributions from 2 Districts, 7 Regions, and 3 combined submissions from Districts and Regions. This section

assesses research impacts on areas such as changes to practice, knowledge sharing and influencing practice

along the continuum of care.

Table 6: Long-Term Impacts Achieved identified in the OSN Regional Team Survey

Long-Term Impacts High (2)

Med (1)

Low (0)

No Response

Awareness 7 5

Changes to Practice 7 3 2

Knowledge Sharing 8 1 2 1

Sustainability 6 2 3 1

Overall Relevance 4 4 4

The OSN regional teams (located in Regional and District Stroke Centres) reported significant levels of impact from OSN funded projects with an emphasis on Awareness, Changes to Practice and Knowledge Sharing to stroke care. Summary of Findings

A fuller description and breakdown of data detailed in Table 2 is presented below.

Awareness

100% of survey responses indicated knowledge of strategies undertaken to increase awareness of OSN funded research activities and findings among stakeholders such as physicians, nurses, allied health professionals, and patients.

The OSN website, OSN Communique, newsletters, conference presentations, poster sessions, regional steering meetings, provincial stroke rounds, health fairs, public forums, researcher presentations, journal articles, core team meetings and committee involvement were identified as valuable tools for knowledge translation of research activities and findings.

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58% of survey respondents indicated that they implemented changes in practice as a result of OSN funded research and 25% of survey respondents said that they had initiated change in practice. Examples include:

Implementation of an effective education program in more than one region with plans to expand program to other regions (CISCCOR/Collaborative Interprofessional Stroke Care in Community Re-engagement, 2008/09).

Delivery of interprofessional program targeting health providers working in community and LTC settings (Brain Body and You Study, 2006/07).

Knowledge Sharing 67% of respondents participated in sharing of OSN research findings and activities with other regions in the province (either as a provider or recipient of knowledge exchange).

Partnership with the Registered Nurses Association of Ontario (RNAO) to post the stroke modules on the RNAO tool kit website resulting in increased awareness of LTC staff to identify the signs and symptoms of stroke and utilize best practice strategies with their residents who have had stroke. (Strategic Processes for Implementing Stroke Best Practices in Long Term Care Homes in Central South Stroke Region, 2007/08).

Impact on overall health of stroke patients participating in the Moving with Stroke program. Research findings resulted in the creation of a new DVD training resource and are included in the “Guidelines for Community Based Exercise Programs for People with Stroke (2010)”. To date 171 DVDs have been disseminated to clinicians in 49 cities in Canada, USA and Australia (Evaluation of the impact of an eight-week, stroke-specific exercise programme developed by physiotherapists and delivered in the community by trained fitness facilitators, 2007/08).

Sustainability 50% of respondents indicated success in sustainability of changes in practice that were implemented in their district/region.

Knowledge received from carotid project is informing development of regional carotid intervention (A point-of-care, quality assurance project evaluating rapid access to carotid ultrasound in patients experiencing recent symptoms of transient ischemic attack, 2008/09).

Development of trigger tools/algorithms to sustain practice beyond the research period such as the Community Reengagement Trigger Tool (CISCCOR/Collaborative Interprofessional Stroke Care in Community Re-engagement, 2008/09).

Overall Relevance 67% of respondents indicated medium to high recognition of value of OSN funded research in overall relevance category.

Respondents recognized there has been a more concerted effort to fund research that addresses system, service and clinical gaps and needs.

Secondary Prevention Clinic (SPC) research undertaken was identified as example of research that addressed a gap and responded to a need in the OSS community resulting in a new case record form and data collection tool being developed. (Evaluating the Quality of Secondary Prevention Clinic Data in Ontario, 2009/10).

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Looking ahead

Regions indicated that they were mostly familiar with OSN funded research projects and findings that were undertaken in their regions.

o The OSN will investigate further how to better communicate successful project outcomes to other regions and districts across the province.

The favoured mode of knowledge exchange appears to occur at the regional and core team meetings and specific forums.

o The OSN will facilitate and engage Regional Stroke Teams to having researchers more actively engaged in outreach and making presentations.

Regions have been involved in specific research projects addressing stroke care gaps however sustainability and practice change has not necessarily been broadly achieved.

o The OSN will consult with the regional stroke teams and researcher community to identify strategies for knowledge exchange from project findings to stroke care providers/organizations.

o Development of a monitoring mechanism linking knowledge transition initiatives through the Ontario Regional Education Group (OREG) to facilitate uptake of research knowledge into practice.

Development of a mechanism for capturing the success factors that support sustainable practice change and transfer ownership of the program/ best practice to health care providers. This performance measure will be investigated and assessed in future.

The creation of a strategically aligned OSN Research Program, using the OSN Managed Research Cycle, continues to make the direct translation of the research investment into improvements in patient care clearer to understand.

o The OSN Research Committee will oversee the implementation of the OSN Managed Research Cycle

OSN Regional Team awareness of outcomes and impacts will be evaluated annually in order to ensure ongoing improvement of dissemination activities enhancing long-term impacts of the OSN research program.

“Our project was successful because we engaged the regional stroke networks throughout the whole process of

the research project. Committed stakeholders (physicians, program directors, clinical data staff, multilevel and

interprofessional individuals) contributed to the research planning, development and implementation of a new

data collection tool. Widespread acceptance ensures uptake of new tools.”

Ruth Hall, Institute for Clinical Evaluative Sciences (ICES), OSN Researcher

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High Impact Case Studies Identified by OSN Regional Team Survey

Four case studies of OSN funded projects (FYS 2006/07 – 2009/10) were identified as a result of the OSN Regional Team Survey as having high impact in influencing practice at all stages across the continuum of care.

Researchers participating in the case study reviews were interviewed and invited to describe new knowledge or tools created, discuss the impact of the research findings across the continuum of care, and identify success factors. CASE STUDIES SUMMARY

Table 7: High Impact Case Studies Identified by OSN Regional Team Survey

Case Study

Year Funded

PI/ Sponsoring Institution Project Title

#1 2006/07 Kathleen Kennedy St. Lawrence College Sue Saulnier Stroke Network of Southeastern Ontario Kingston General Hospital Ruth Doran St. Lawrence College

Development of the Tips and Tools for Everyday Living: A guide for Stroke Caregivers Program for Academic Settings

#2 2007/08 Jill Cameron University of Toronto

The Weekend Home Visit Program during Impatient Rehabilitation: How can we Optimize the Benefits to Stroke Survivors and Family Caregivers Clinical Uptake

#3 2008/09 Donna Cheung St. Michael’s Hospital Jocelyne McKellar Toronto Western Hospital

Collaborative Interprofessional Stroke Care In Community Re-engagement (CISCCoR)

#4 2009/10 Ruth Hall Dr. Moira Kapral Institute for Clinical Evaluative Sciences

Evaluating the Quality of Secondary Prevention Clinic Data in Ontario

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Summary of Findings

Analysis and interpretation of data detailed in Table 2 is presented below. See Appendix D for an expanded

presentation of the new knowledge, impacts and success factors attributed to these research projects.

All high impact case study researchers acknowledged that OSN funding provided either seed funding for

pilot study or ongoing funding to build on the recommendations from earlier studies.

All researchers indicated strong collaborations and partnerships as a key element contributing to success.

Early engagement of researchers and stroke system stakeholders to facilitate project completion is strongly

recommended. OSN researchers and staff are extremely motivated and willing to offer their knowledge.

Recommendation to OSN to consider developing a mentorship program. Experienced researchers could help

front line staff/clinicians/professionals with strong research ideas to develop strong proposals, identify

methodologies, and create partnerships.

Looking ahead

The Call for Proposals will include a section that would outline the plan for project sustainability.

The OSN Research Program will explore opportunities and/or collaborations with agencies to support development and mentorship of new researchers.

“With the 2010 release of the Canadian Best Practice Recommendations on interprofessional communication

and transitions, our work continues to be relevant for those working across the care continuum. The

Community Re-engagement Trigger Tool developed as a result of OSN funding is also transferable to other

patient populations, chronic diseases.”

Donna Cheung, (Rehab and Community Re-engagement Coordinator), St. Michael’s Hospital, OSN Researcher

Jocelyne McKellar, (Rehab and Community Re-engagement Coordinator), Toronto Western Hospital, OSN

Researcher

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APPENDIX A

ONTARIO STROKE NETWORK MANAGED RESEARCH CYCLE13

The Ontario Stroke Network Managed Research Cycle14 provides a framework to support ongoing and

continuous collaboration and knowledge exchange between researchers and knowledge users. The overall aim

of the framework is to determine and inform highly relevant research that has potential for application in care

delivery and policy areas.

13 Adapted from the Heart and Stroke Foundation of Canada: Knowledge Transfer and Exchange in Research: A Guide for Applicants and Reviewers: 2009

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APPENDIX B

RECENT PUBLICATIONS

1) Ahuja C, Mamdani M, Saposnik G. Influence of Socioeconomic Status on Distance Traveled and Care after Stroke. Stroke. 2011; Oct 6. [Epub ahead of print]

2) Burke MJ, Vergouwen MD, Fang J, Swartz RH, Kapral MK, Silver FL, Casaubon LK. Short-term outcomes after symptomatic internal carotid artery occlusion. Stroke. 2011; 42 (9): 2419-2424.

3) Cheung D, McKellar J, Parsons J, Lowe M, Willems J, Heus L, Reeves, S. Community Re-engagement and Interprofessional Education: The Impact on the Healthcare Provider and Persons Living with Stroke. Topics in Stroke Rehabilitation, 2012;19(1):63–74.

4) Fang J, Saposnik G, Silver FL, Kapral MK. Investigators of the Registry of the Canadian Stroke Network.

Association between weekend hospital presentation and stroke fatality. Neurology. 2010 Nov 2;75(18):1589-96.

5) Finestone HM, Guo M, O’Hara P, Greene-Finestone L, Marshall SC, Hunt L, Biggs J, Jessup A. Driving and

Reintegration Into the Community in Patients After Stroke, PM&R, 2010 by the American Academy of Physical Medicine and Rehabilitation. June 2010, (2) 497-503

6) Finlayson O, Kapral M, Hall R, Asllani E, Selchen D, Saposnik G. Risk factors, inpatient care, and outcomes of

pneumonia after ischemic stroke. Neurology. 2011; 77 (14): 1338-1345.

7) Hall R, Khan F, O’Callaghan C, Meyer S, Fang J, Hodwitz K, Bayley M. Ontario Stroke Evaluation Report

2011: Improving System Efficiency by Implementing Stroke Best Practices June 2011

8) Hall R, O'Callaghan C, Bayley M, Meyer S, Khan F, Liu Y, Linkewich B, Lumsden J, Willems D. Ontario Stroke

Evaluation Report 2010: Technical Report. April 2010

9) Herrmann N, Seitz D, Fischer H, Saposnik G, Calzavara A, Anderson G, Rochon P. Detection and treatment of

post-stroke depression: results from the Registry of the Canadian Stroke Network. International Journal of

Geriatric Psychiatry. 2011; Mar 1 [Epub ahead of print].

10) Ireland S, MacKenzie G, Gould L, Koper A, Dassinger D & LeBlanc K. Nurse case management to improve risk reduction outcomes in a stroke prevention clinic. Canadian Journal of Neuroscience Nursing. (December, 2010). 32(4), pp.7-13.

11) Ireland S, Arthur H, Gunn E & Oczkowski W. Stroke Prevention Care Delivery: Predictors of Risk Factor Management. International Journal of Nursing Studies. (2010) 48(2), 158-164.

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12) Jin YP, Di Legge S, Ostbye T, Feightner JW, Saposnik G, Hachinski V. Is Stroke History Reliably Reported by Elderly with Cognitive Impairment? A Community-Based Study. Neuroepidemiology. 2010 Jul 27;35(3):215-2 20.

13) Kapral MK, Degani N, Hall R, Fang J, Saposnik G, Richards J, Silver FL, Robertson A, Bierman AS. Gender Differences in Stroke Care and Outcomes in Ontario. Womens Health Issues. 2011; 21(2):171-6.

14) Kagan A. A-FROM in action at the Aphasia Institute. Seminars in Speech and Language. 2011 Aug; 32(3):216-28. Epub 2011 Sep 23.

15) Lee TC, Goodman SG, Yan RT, Grondin FR, Welsh RC, Rose B, Gyenes G, Zimmerman RH, Brossoit R, Saposnik G, Graham JJ, Yan AT. Disparities in management patterns and outcomes of non-ST elevation acute coronary syndrome patients with and without prior history of cerebrovascular disease. American Journal of Cardiology. 2010 Apr 15;105(8):1083-9.

16) MacKenzie G., Gould L., Ireland S., LeBlanc K. and Sahlas D. Detecting cognitive impairment in clients with

mild stroke or transient ischemic attack attending a stroke prevention clinic. Canadian Journal of

Neuroscience Nursing. (2011) 33 (1), 47-50.

17) McKellar JM, Cheung D, Lowe M, Willems J, Heus L, Parsons J.Healthcare providers’ perspectives on an

interprofessional education intervention for promoting community re-engagement post stroke. Journal of

Interprofessional Care. 2011 Sep;25(5):380-2. Epub 2011 Jul 8.

18) Meyer M, Murie-Fernandez M, Hall R, Liu Y, Fang J, Salter K, et al. Assessing the impact of thrombolysis on

progress through inpatient rehabilitation after stroke: a multivariable approach. International Journal of

Stroke. 2012 Jan 20 [Epub ahead of print].

19) Minore JB, Hill ME, and Bodnar P. Developing a stroke education tool for First Nation people. Stroke. 2010, 41(7): E483.

20) Prior PL, Hachinski V, Unsworth K, Chan R, Mytka S, O'Callaghan C, Suskin N. Comprehensive Cardiac Rehabilitation for Secondary Prevention After Transient Ischemic Attack or Mild Stroke: I: Feasibility and Risk Factors Stroke. 2011;42:3 207-3213

21) Redelmeier DA, Arbour, K, Lu H, Saposnik G. Roadway Crash Risks in Recent Immigrants. Accident Analysis and Prevention 2011; Nov;43(6):2128-33.

22) Saposnik G, Levin M. Virtual Reality in Stroke Rehabilitation: a meta-analysis and implications for clinicians. Stroke 2011; 42: 1380-1386.

23) Saposnik G. Hassan KA, Selchen et al. Stroke Unit Care: does stroke subtype matters? International Journal of Stroke 2011; 6(3): 244-250.

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24) Saposnik G, Kapral MK, Liu Y, Raptis R, Hall R, O’Donnell M, Tu J, Mamdani M, Austin PA. IScore: A Risk Score to Predict Death early after Hospitalization for an Acute Ischemic Stroke. Circulation 2011; 123: 739-49.

25) Saposnik G, Fang J, Kapral MK, Tu JV, Mamdani M; Austin P; Johnston, on behalf of the Investigators of the Registry of the Canadian Stroke Network (RCSN) and the Stroke Outcomes Research Canada (SORCan) Working Group. The iScore predicts effectiveness of thrombolytic therapy for ischemic stroke. Stroke 2012.

26) Saposnik G. The Role of Vitamin B in Stroke Prevention: A Journey From Observational Studies to Clinical Trials and Critique of the VITAmins TO Prevent Stroke (VITATOPS). Stroke 2011; 42(3):838-42.

27) Saposnik G, Kapral MK, Liu Y, Raptis R, Tu J, Mamdani M, Austin PA. The IScore predicts poor functional outcomes early after Hospitalization for an Acute Ischemic Stroke. Stroke 2011 Sep 29. [Epub ahead of print]

28) Saposnik G. The missing ethnicity in primary cardiovascular trials. QJM. 2011; 104(6):551-2.

29) Saposnik G, Mamdani M, Bayley M, Thorpe J, Hall J, Cohen LG, Teasell R. Effectiveness of Virtual Reality

Exercises in STroke Rehabilitation (EVREST): Rationale, Design, and Protocol of a Pilot Randomized Clinical Trial Assessing the Wii Gaming System. International Journal of Stroke 2010; 5:47–51.

30) Saposnik G, Mamdani M, Liu Y, Raptis S, Rochon P, Kapral M, Cote R, Black S. Care and Outcomes in Patients with Ischemic Stroke with and without Pre-existing Dementia. Neurology 2011 Nov 1;77(18):1664-1673.

31) Saposnik G. Meta analysis suggests that folic acid supplementation does not reduce risk of stroke, but there may be some benefit when given in combination with vitamins B6 and B12 and in primary prevention. Evidence Based Medicine 2010 Dec;15(6):168-70.

32) Shi Q, Presutti R, Selchen D, Saposnik G. Delirium in Acute Stroke : a systematic review and meta-analysis.

Stroke. 2012; 43: 645-649.

33) Smith EE, Hassan K, Fang J, Selchen D, Kapral MK, Saposnik G. Do all stroke subtypes benefit from organized

care? Neurology 2010; 75:456-62.

34) Taylor D, Stone S and Huijbregts M. Remote participants' experiences with a group-based stroke self-management program using videoconference technology. Journal of Remote and Rural Health Issue 1, 2012 (volume 12).

35) Webster F, Saposnik G, O’Callaghan C, Fang J, Hachinski V. Organized Outpatient Care: Stroke prevention clinic referrals are associated with reduced mortality after TIA and ischemic stroke. Stroke 2011 Nov;42 (11):3176-82.

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APPENDIX C

SUMMARY OF NEAR-TERM OUTPUTS FROM RESEARCH PROJECTS (FY 2009/11) In the following table a summary of completed FY 2009/10 OSN-funded research projects is presented highlighting project objectives, new knowledge or tools created and implications for change to practice and health care system delivery.

Near Term Outputs 2009/11 Projects

Summary of New Knowledge (Key Findings from Project Final Reports)

PI/Sponsoring Organization

Dr. Dina Brooks University of Toronto

Dr. Nancy Salbach University of Toronto

Project Title Investigating the relationships between clinical and laboratory-based measures of exercise capacity and measures of physical activity in daily life in individuals post stroke

Objective A cross-sectional study of 20 community-dwelling people with stroke was conducted to determine how aerobic capacity and daily physical activity relate to performance on the 6-minute walk test (6MWT).

The 6MWT is a valid and reliable measure of walking capacity post-stroke. The 6MWT has also demonstrated sensitivity to change when used as a measure of outcome in randomized controlled trials of exercise interventions in stroke

New Knowledge or New Tool

Contribution to existing literature describing the cardiorespiratory responses observed in people with stroke completing the6MWT.

Preliminary findings from the current study suggest that aerobic capacity is challenged during the 6MWT, and 6-minute walk distance (6MWD) relates to daily physical activity.

Implications In summary, preliminary findings will help to promote the relevance and use of the 6MWT as an indicator of aerobic fitness, and to assist with goal setting and treatment planning to promote physical activity in the community.

Improvement in 6MWT performance may be increase the likelihood that people with stroke will engage in walking activity after discharge from rehabilitation, which will enable them to maintain or achieve higher levels of health and prevent the negative consequences of inactivity.




Dr. Mary Egan University of Ottawa

Project Title Measuring engagement in valued activities and its health benefits among stroke survivors living in long-term care facilities

Objective To test a protocol for examining engagement in personally valued activities among people discharged to residential care;

Provide preliminary evidence for the link between engagement in valued activities and well-being; and,

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Identify factors that facilitate or limit participation in this setting.


Stroke survivors discharged to retirement homes may be at particular risk for lowered participation in valued activities, which may play an important role in depression.

Personal Projects Analysis provides a useful tool for identifying personally valued activities which could be used to form participation goals. With practice, individuals with cognitive and language deficits can use this tool.

Implications Results provide preliminary support for facilitating engagement in personally valued activities is an effective way to promote emotional well-being in this population.

Stroke survivors discharged to retirement homes may benefit particularly benefit from interventions to enhance participation and potentially reduce the risk of depression




Dr. Gustavo Saposnik St. Michael's Hospital

Project Title S.O.S. Stroke Care - Evaluating gaps along the continuum in stroke care

Objective Antihypertensive and lipid-lowering therapies are key elements of stroke prevention and quality of stroke care. The researchers examine whether prescription/use of at least one of these therapies at discharge continues post-discharge.

A retrospective cohort study was conducted examining 6347 ischemic stroke patients aged 66 years and older to determine the continuity (from hospital to community) of evidence-based stroke care with antihypertensive and lipid lowering agents.


Preliminary findings indicate that 8.6% of all ischemic stroke patients have not received a prescription for either antihypertensives or lipid lowering agents at hospital discharge.

Some ischemic stroke patients (31.3%) have a history of prior use of either antihypertensives or lipid lowering agents; the majority of patients (68.7%) have no prior history of taking either of these preventive therapies.

45.5% of those with no prior history for taking antihypertensives or lipid lowering agents were provided with a prescription for at least one of these therapies at discharge, while 89.8% of patients having a prior history of using at least one of these therapies received a prescription at discharge.

Implications Identifying factors which lead to a gap in the continuity of care (from the inpatient to outpatient setting) will permit new or improved tactics to encourage use of preventive therapies in the stroke population, andprovide insight into factors contributing to adherence of medication use for other patient populations.




Dr. Robert Teasell St. Joseph’s Health Care London Lawson Health Research Institute and University of Western Ontario

Project Title An Economic Model for Stroke Rehabilitation in Ontario: Mapping Resource Availability

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and Patient Needs

Objective To assess the availability of post-stroke rehabilitation resources across Ontario,

To begin to identify the impact that these resources have on the accessibility of inpatient rehabilitation, and

To identify where future investment may be likely to have the greatest impact


Survey results indicate that current rehabilitation resources are insufficient and modeling results suggest that patients are not able to access the services they need.

Economic estimates suggest the need for investment in the rehabilitation sector.

Results suggest that current rehabilitation resources in Ontario are insufficient to meet the annual need for services.

Implications Study results have led to ongoing work with the OSN and MOHLTC Rehab/CCC ER/ALC Expert Panel to further evaluate the need for and impact of changes in Ontario’s stroke rehabilitation system.

Survey and model results have been made available to several LHIN representatives and ongoing work will be completed to help these regions evaluate their current system and assess the need for change.




Gail MacKenzie Hamilton Health Sciences

Project Title Tailored Interventions to Improve Hypertension Management After Stroke or TIA Study - Phase II (TIMS II)

Objective To investigate the effectiveness of a case management approach in reducing blood pressure (BP) and improving medication self-efficacy and adherence in a group of clients at risk for non-achievement of treatment targets.


Telephone follow-up was valued by the intervention participants and did not take a major time commitment from the Secondary Prevention Clinic (SPC) nurses.

The SPC nurses gained insight and understanding of the challenges clients face in making lifestyle changes, and were able to identify helpful strategies.

Most participants indicated they made some lifestyle changes during the 6 month follow-up period.

Preliminary analysis for 55 participants demonstrated both intervention (INT) and usual care (UC) participants achieved BP reductions.

Implications Results suggest that SPCs are effective in assisting clients to reduce BP. More intervention (INT) participants reached Best Practice Guideline BP targets.

Adoption of routine screening questions for medication adherence and the MoCA tool for assessment of mild cognitive deficits by three (3) additional SPC’s

Reduction of BP through effective management will contribute to reduced risk of stroke recurrence.

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Krystyna Skrabka South East Toronto Stroke Network

Project Title Effect of the Implementation of an Inpatient Code Stroke Protocol on Outcomes and Staff Knowledge

Objective To evaluate the effectiveness of implementing a hospital - wide Inpatient Code Stroke Protocol (ICSP) through process change and knowledge translation indicators.


Implementation of the ICSP resulted in improvement in the process indicators related to assessment and treatment of hyper-acute stroke.

o 24% reduction in time from initial physician assessment (IPA) to CT scan; 72% reduction in time form last seen normal (LSN) to IPA; 59% reduction in time form LSN to CT scan; 13% reduction in post stroke complications.

The percentage of stroke in the surgical populations decreased by 17%, the number of non-surgical strokes likely remained the same, and recognition of stroke symptoms by hospital staff increased.

In the majority of cases, the code stroke was activated either by the medical resident or staff physicians, however, in 6% and 3% of cases a code stroke was activated by a Registered Nurse (RN) or Nurse Practitioner (NP) respectively.

An ICSP e-learning package has been developed and will be used in staff and resident orientation as well as a knowledge refresher for staff which will lead to a positive change in practice in patient care.

Implications The ICSP tool facilitated an improvement in process change leading to enhanced response and intervention for inpatients who suffer acute stroke.

An ICSP e-learning package has been developed and will be used in staff and resident orientation as well as a knowledge refresher for staff to support sustainability of knowledge.





Project Title Teach Our Children: Stroke Awareness for Aboriginal Youth

Objective To assess what Aboriginal youth understand about stroke, what they need to know about stroke and how to deliver this information in a culturally- and age-appropriate manner.


The findings revealed considerable variability in Aboriginal youth’s knowledge about stroke. Some communities, with strong health programming, had very well informed youth; in other locations, there was less awareness.

Development of a culturally and age-appropriate DVD stroke education tool for Aboriginal youth based on interviews with health and education professionals and discussion groups with youth and featuring Anishnawbe youth teaching their peers about stroke.

Based on feedback from the NWORSN Aboriginal Advisory Committee and people in

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participating First Nations, the DVD will be used extensively in the communities, their schools and health care organizations.

The DVD will be available for use by health and education professionals to heighten the awareness of signs and symptoms of stroke.

Implications Confirms the importance of conducting stroke research in partnership with Aboriginal communities and with the direction of an Aboriginal Advisory Committee.

It also emphasizes, from a policy perspective, the need for researchers to allow sufficient time to engage Aboriginal communities and organizations in the research and in the development of educational tools and products.

Over the longer-term, increased awareness may encourage more timely response to stroke and, ultimately, contribute to better outcomes for stroke survivors.




Ruth Hall/ Dr. Moira Kapral Institute for Clinical Evaluative Sciences

Project Title Evaluating the Quality of Secondary Prevention Clinic Data in Ontario

Objective To assess the quality of the Stroke Performance Indicators for Reporting, Improvement and Translation (SPIRIT)-SPC database, evaluate care provided at secondary stroke prevention clinics in Ontario from FY 2007– 2011, and create a researchable database.


The importance of having a data collection tool that dictates what data is to be input. (ie. the tool should not allow the user to decide what data to include). Tool must determine when a file is considered to be complete.

Wide variation in the degree of data completeness and records input (eg. Some sites only input stroke/TIA patients not suspected cases).

Wide variation in how sites were triaging patients.

SPC datasource provided limited information on SPCs across the province. The researchers were not able to have a complete evaluation of SPC quality of care due in Ontario due to incomplete data as well as site specific triage tools. Eg. Researchers could not evaluate timeliness of SPC clinic visit due to inconsistent triaging definitions.



Implications The results revealed technical limitations of the data collection tool, inconsistency in data entry and the non-standardized triage tools used across sites, and highlighted the need for a revised data collection tool and a formal audit of SPCs in Ontario.

An audit of all 40 SPCs in Ontario will be conducted beginning April 2012 and will provide better understanding of the models of care delivered at SPC sites in the province

Led by the OSN Best Practice Secondary Prevention/Acute Care Subcommittee, the revised triage algorithm will be recommended for adoption by the stroke regions in 2012.

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APPENDIX D

SUMMARY OF HIGH IMPACT CASE STUDIES

In the following table four case studies of OSN funded projects (FYs 2006/07 – 2009/10) is presented. Researchers were interviewed and invited to describe new knowledge and tools, impacts and success factors attributed to these research projects.

Case Study #1 Development of the Tips and Tools for Everyday Living: A guide for Stroke Caregivers Program for Academic Settings


Kathleen Kennedy St. Lawrence College

Sue Saulnier Stroke Network of Southeastern Ontario Kingston General Hospital

Ruth Doran St. Lawrence College

Year Funded 2006/07

New Knowledge The “Brain Body and You” continuing educational (CE) program is an effective method for teaching regulated and unregulated front line health care providers (HCP) working in long-term care (LTC) and community settings the knowledge and skills required to care for stroke survivors. Reaching an interdisciplinary group and imbedding the principles of interprofessional education into the program had not been undertaken before. The collaborative, interprofessional (IP) team approach taken in the development and delivery of “The Brain, The Body and You” program has enriched the learning experience of all participants and workshop facilitators.

Impact This sustainable program is delivered at multiple sites including hospital, college and long-term care settings, sponsored by the St. Lawrence College. The Southeast Ontario (SEO) Stroke Network covers the cost of 2 complete series per year and other organizations including a community hospital and the Community Care Access Centre have funded additional sessions through St. Lawrence College.. 909 participants have completed or registered for the course (up to March 2012).

The collaborative nature of the CE program reaffirms for regulated and non-regulated staff that they are respected members of the interprofessional team.

The interdisciplinary collaboration required in the development and delivery of training allows health care educators to work directly with professionals in the field ensuring the most current best practice education for participants/undergraduates.

Much of the education is being identified by participants as being transferrable to other health care domains (e.g. Parkinson’s, Acquired Brain Injury (ABI), Alzheimer’s)

Success Factors Collaboration and support from the SEO Stroke Network, St. Lawrence College, LTC Collaborative, Regional education partners

Commitment of research project leadership to communicate and advocate this program with existing health care groups, and willingness to create new linkages where none previously existed.

Addresses a gap for professional development opportunities for other unregulated members of the health care team (e.g. housekeeping, porters).

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No cost for unregulated and regulated HCP to participate. The SEO Stroke Network cover the training costs for 2 full sessions per year. Other health care organizations have also funded the training program (ie. Community Care Access Centres (CCAC) and Quinte Health Care (QHC), Belleville Ontario.

Case Study #2 The Weekend Home Visit Program during Impatient Rehabilitation: How can we Optimize the Benefits to Stroke Survivors and Family Caregivers? Clinical Uptake



Year Funded 2007/08

New Knowledge Health care professionals identified safety in the home as a primary concern and recognized a need to prepare patient and family for the transition from health care setting to home. The health care team, caregivers and stroke patients viewed the Weekend Pass (WP) program as a valuable way to facilitate transition home but felt improvements to program delivery would enhance the experience. Clinical Uptake

Enhancement of/ modification to WP program at the Toronto Rehabilitation Institute

Training Changes

Weekend pass included in Timing it Right Stroke Family Support Program currently being evaluated in multi-site RCT funded by Heart and Stroke Foundation.

Possible changes to practice at local rehabilitation facilities through co-investigator involvement and presentation at provincial stroke meetings/workshops

Impact Has directly contributed to Canadian Stroke Strategy Best Practice Recommendations and shaped a new focus in 2010 to improving transitions from health care facility to home.

Follow-on research funding secured from the Heart and Stroke Foundation for current research project and the investigator was awarded a CIHR New Investigator Award and Ministry of Research and Innovation Early Researcher Award (2011)

Subsequent research is examining ways that this program can be implemented and evaluated at sites across the country.

Success Factors Excellent partnership with Toronto Rehab Institute, and support from HCP team (masters student, co-investigators, collaborators)

Funding for this project was essential to the project being completed. Without funding only caregiver experiences would have been investigated. The relatively quick turnaround of OSN funding decisions (4-5 months), the higher success rate (~50%) than larger funding organizations, and OSN support towards applied research were critical to success of this project.

Partnership with Toronto Rehab Institute as an organization that understands and supports the need for research.

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Case Study #3 Collaborative Interprofessional Stroke Care In Community Re-engagement (CISCCoR)


Donna Cheung St. Michael’s Hospital

Jocelyne McKellar Toronto Western Hospital

Year Funded 2008/09

New Knowledge This study was designed to facilitate the adoption of interprofessional collaboration (IPC) and community re-engagement (CR) stroke best practices by health care providers (HCPs) working along the care continuum. The integration of the CR framework and concepts of IPC in the educational intervention provided HCPs with a shared framework and language from which to work from when considering the complex needs of persons with stroke. A CR trigger tool was developed built on the eight components of CR stroke best practices framework and serves as a guide for HCPs to work in a holistic manner when engaging persons with stroke and their caregivers.

Impact CISCCoR has been identified as an ongoing effective education intervention in more than one stroke region.

High level dissemination of study and its results through videoconference for the Central East, Northwestern Ontario, and Southwestern Ontario Stroke Networks (Feb 2011), presentations in scientific journals15,16, poster presentations (9), conferences (e.g. LIVE conference through the March of Dimes Canada), newsletters and other conferences and symposiums.

CR trigger tool is an effective and useful tool to bring to rounds and to use when engaging persons with stroke, which facilitates a reflective and holistic approach.

HCPs acknowledged the value of IPC for patient-centred goal-setting and the advantages of having a common framework and language for assessments, discharge planning, and interprofessional communication and role clarity.

There is an increased awareness for the need for a CR approach when working with persons with stroke

The CR framework and trigger tool has been integrated in the Toronto Regions’ Stroke Network’s Stroke Passport and peer support initiative part of theTransition Improvement for Continuity of Care(TICC) initiative and into the CCAC’s CCR.

Aligns with the Canadian Best Practice Recommendations 2010 Update on interprofessional communication and transitions,

Success Factors The knowledge transfer and exchange activities (commitment to action, peer sessions, follow up) were essential to the study’s success.

The CR trigger tool was identified as an excellent resource that served as a reminder to apply knowledge to action.

Engaging IPC Leader, and care teams along the continuum (acute, rehabilitation, and community), were essential factors contributing to the success of this project.

Peer sessions and follow up interviews was a reminder for HCPs to facilitate knowledge translation.

15Cheung D, McKellar J, Parsons J, Lowe M, Willems J, Heus L, Reeves, S. Community Re-engagement and Interprofessional Education: The Impact on the Healthcare Provider and Persons Living with Stroke.Topics in Stroke Rehabilitation, 2012;19(1):63–74. 16McKellar JM, Cheung D, Lowe M, Willems J, Heus L, Parsons J.Healthcare providers’ perspectives on an interprofessional education intervention for promoting community re-engagement post stroke. Journal of Interprofessional Care. 2011 Sep;25(5):380-2. Epub 2011 Jul 8.

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Academic researcher mentored the investigators and assisted in the development of research questions, methodology, and knowledge translation and evaluation strategies.

Organizational support for researchers to deliver the program to sites

The CR trigger tool developed is also transferable to other chronic disease patient populations

Case Study #4 Evaluating the Quality of Secondary Prevention Clinic Data in Ontario


Ruth Hall/ Dr. Moira Kapral Institute for Clinical Evaluative Sciences

Year Funded 2009/10

New Knowledge The importance of having a data collection tool that dictates what data is to be input. (ie. the tool should not allow the user to decide what data to include). Tool must determine when a file is considered to be complete.

Wide variation in the degree of data completeness and records input (eg. Some sites only input stroke/TIA patients not suspected cases).

Wide variation in how sites were triaging patients.

SPC datasource provided limited information on SPCs across the province. The researchers were not able to have a complete evaluation of SPC quality of care due in Ontario due to incomplete data as well as site specific triage tools. Eg. Researchers could not evaluate timeliness of SPC clinic visit due to inconsistent triaging definitions.



Impact New case record form (CRF) that engaged the system/stakeholders – that met their needs as well as research and provincial system needs was created.

Findings and revised CRF resulted in the Acute and Secondary Prevention BP group developing a standardized triage tool to be developed for the OSS Secondary Prevention Clinics (SPCs)

As a result of the findings, the first Secondary Prevention Clinic site audit (40 sites) has been planned for 2012. The anticipated results are expected to contribute and inform the current ER/ALC issue.

Success Factors Highly engaged interprofessional advisory committee (various representatives within OSS – e.g. physicians, program directors, clinic data people; multilevel and interprofessional people) involved in the whole process of the research project and in particular in developing new data collection tool and form.

Highly competent staff in the ICES stroke office, in particular those familiar with the data; ability to address technical issues such trying to incorporate personal health variables to include in the database to allow for SPC data linkage to other health

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databases.

Widespread recognition and acceptance of the importance of this work was necessary to ensure uptake of new tools

The Acute and Secondary Prevention Best practice Committee’s involvement in the refining the triaging algorithm with the case record form

The research addressed a clear gap identified by the OSN

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APPENDIX E

HISTORY OF OSS/OSN FUNDED PROJECTS

Researcher Institution Project Title Year

Funded

Laura Syron Heart and Stroke Foundation of Ontario

Evidence of Stroke Rehabilitation Research Project 2000-01

Andreas Laupacis

Institute for Clinical Evaluative Sciences

Funding for Canadian Stroke Registry 2000-01

Joe McReynolds

Ontario Community Support Association

Best Practices for Community Agencies with Respect to Stroke

2000-01

Susan Donaldson

Ontario Association of Community Care Access Centres

Best Practices for Community Care Access Centres with Respect to Stroke

2000-01

Laura Syron Heart and Stroke Foundation of Ontario

Best Practices in Long-Term Care Facilities with Respect to Stroke

2000-01

Andrew Scipio del Campo

Heart and Stroke Foundation of Ontario

Long Term Stroke Care in Facilities and Community 2001-02


Overcoming Communication Barriers for Stroke Patients with Aphasia

2001-02

Andrew Scipio del Campo


Long Term Stroke Care in Facilities and Community 2002-03

Mary Lewis Heart and Stroke Foundation of Ontario

Best Practices Guidelines for Stroke Care 2002-03

Mary Lewis Heart and Stroke Foundation of Ontario

Nursing Best Practice Guideline for Stroke Assessment 2002-03

Robert Teasell

St. Joseph’s Health Care London, Lawson Health Research Institute and University of Western Ontario

Rehabilitation Research into Stroke Evidence Based Review and the Chedoke Arm and Hand Activity Inventory

2003-04

Katherine Lafferty

University of Ottawa

Collection of Ontario Data for the National Stroke Registry

2003-04

Ellen Rukholme and Linda Kelloway

The Trillium Health Centre

Converting Stroke Best Practices Into a Province Wide Tele-Education Module

2004-05

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Funded

Frank Silver/Moira Kapral

The Canadian Stroke Network

The Canadian Stroke Network Registry Project 2004-05

Vladimir Hachinski and Neville Suskin

London Health Sciences Cardiac Rehabilitation Programming as Secondary Prevention for Survivors of Transient Ischaemic Attacks and Mild Non-disabling Strokes

2004-05

Jon Erik Ween

Sunnybrook and Women's College Health Science Centre

Collaborative Development of an Affect-Behavior-Cognitive Assessment Battery and Point of Care Case Record for Implementation with Wireless Device Technology in the Local Stroke Care Continum

2005-06

Dan Selchen The Trillium Health Centre

Triage and Referral Tool Kit for the Regional Stroke Prevention Clinic

2005-06


A Participation-Based Framework for Outcome Measurement in Aphasia

2006-07

Vince DePaul St. Joseph’s Healthcare Hamilton

A Motor Learning-Based Walking Program versus Body

Weight Supported Treadmill Training in Community

Dwelling Adults within Six Months of Stroke Onset: A

Randomized Controlled Trial

2006-07

Rosemary Martino

University Health Network

Development of a Web-Based Course to Maintain Skills in

Nurses Trained to Screen for Dysphagia

2006-07

Cheryl

Jaigobin

University Health

Network

Measuring Best Practices and Quality of Care through

Telestroke in Ontario

2006-07

Sue Saulnier Kathleen Kennedy/ Ruth Doran

Stroke Network of Southeastern Ontario Kingston General Hospital St. Lawrence College

Development of the Tips and Tools for Everyday Living: A guide for Stroke Caregivers Program for Academic Settings

2006-07

Andrea Fisher

Ottawa Health Research Institute

Knowledge Translation of Evidence-Based Recommendations for Continence Care of Stroke Patients in Acute and Rehabilitation Settings (a.k.a. "an evidence-based approach to urinary and bowel management…")

2006-07

Kathryn King, Kelly Waid

Hamilton Health Sciences Corporation

Strategic Processes for Establishing Stroke Best Practice Guidelines in Diverse Long Term Care Homes in Central South Ontario

2006-07

Janet M. Kasperski

The Ontario College of Family Physicians

Ontario Stroke Strategy: Patient Centered Circle of Stroke Support Project

2006-07

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Funded

Frank L. Silver

The Canadian Stroke Network

Ontario Secondary Stroke Prevention Data Registry 2006-07

Donna Quiggan

University of Ottawa Evaluation of post stroke transition programs

2006-07

Gabrielle deVeber

The Hospital for Sick Children

Childhood Stroke Pilot Project 2006-07

Vladimir

Hachinski

Lawson Health Research

Institute

The Impact of Secondary Prevention Clinics (SPCs) in the

Province of Ontario

2006-07

Caroline Gangji


Stroke Rehabilitation System Consensus Panel Project 2006-07

Frank L. Silver


Survey of Physician Care Practices in Ontario for the Treatment of Hyperglycemia in the Early Stages of Stroke

2006-07

Chelsea Hellings

ICES An Environmental Scan of Services Available for Stroke Patients in Long-term Care Homes across Ontario

2007-08

Ivana Yau Hospital for Sick Children Moving from Paediatric to Adult Care: Transitional Needs of Childhood Survivors of Stroke

2007-08

Robert Teasell

St. Joseph’s Health Care London, Lawson Health Research Institute and University of Western Ontario

Blueprint for Transforming Stroke Rehabilitation in Canada: Research Synthesis of Effectiveness and Cost-Benefits

2007-08

Judy Winter Alexandra Hospital Oxford Blood Pressure Education Program 2007-08

Rebecca Fleck

Central South Regional Stroke Program

Strategic Processes for Implementing Stroke Best Practices in Long Term Care Homes in Central South Stroke Region

2007-08

Sandra Ireland

McMaster University Tailored Interventions to Improve Management After Stroke or TIA Pilot Study (TIMS)

2007-08


The Weekend Home Visit Program during Impatient Rehabilitation: How can we Optimize the Benefits to Stroke Survivors and Family Caregivers?

2007-08

Jon Erik Ween

Baycrest

IntegratedNeuroCognitive Assessment System (INCAS) 2007-08

Bruce Minore

Lakehead University Aboriginal Stroke Educational Strategy 2007-08

Esmé French Thunder Bay Regional Health Sciences Centre Regional Stroke Program

Evaluation of the impact of an eight-week, stroke-specific exercise programme developed by physiotherapists and delivered in the community by trained fitness facilitators.

2007-08

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Funded

Denise Taylor

St. Joseph’s Care Group

Clients' perceptions on factors influencing their participation in a group stroke self-management program using videoconference technology: a qualitative study.

2007-08

Mary Egan University of Ottawa Participation in valued activities following stroke 2007-08

Gustavo Saposnik

St. Michael’s Hospital

Premature Stroke Associated With Regency of Immigration to Ontario (PRESARIO)

2007-08

Mary Egan University of Ottawa Navigating Community: Charting the Course 2007-08


Communicative Access Measures for Health Systems: Development and Evaluation

2007-08

Anna Bluvol St. Joseph’s Health Care, Parkwood Hospital

Evaluation of blood pressure self – monitoring in inpatient stroke rehabilitation: does it improve self-management practices and blood pressure control in hypertensive patients after discharge?

2008-10

Alan Chan Baycrest Centre The "Health Information and Knowledge for Youth" (HIKY) Social Network: Development, implementation, and evaluation of social networking site for stroke prevention and health promotion in adolescents

2008-10

Donna Cheung/ Jocelyne McKellar

St. Michael’s Hospital Toronto Western Hospital

Collaborative Interprofessional Stroke Care In Community Re-engagement (CISCCoR)

2008-10

Demetrios Sahlas

Central South Regional Stroke Centre / Hamilton General Hospital, Hamilton Health Sciences

A point-of-care, quality assurance project evaluating rapid access to carotid ultrasound in patients experiencing recent symptoms of transient ischemic attack.

2008-10

Esmé French Thunder Bay Regional Health Sciences Centre

Tele-Rehab: Improving Access to Quality Stroke Rehabilitation in Rural and Remote Communities

2008-10

Andrea Fisher

Ottawa Health Research Institute

Evaluating an online self-learning portal supporting the implementation of stroke care clinical practice guidelines

2008-10

Gustavo Saposnik

St. Michael’s Hospital, Li Ka Shing Knowledge Institute

Effectiveness of Virtual Reality Exercises in STroke Rehabilitation (EVREST)

2008-10

Jill Cameron University of Toronto Enhancing the community re-integration of Chinese stroke survivors and their family caregivers: Phase 1 - Determining their experiences and needs

2008-10

Julie Richardson

McMaster University Rehabilitation in the home environment: A knowledge transfer project to implement best practice and ensure continuity of care with stroke

2008-10

Aura Kagan Jeffery Hoch

Aphasia Institute Psychometric evaluation of the 'Assessment for living with Aphasia': A tool to support data-driven treatment and policy decisions in the area of stroke

2008-10

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Funded

Kathryn Lockington

Maple Family Health Team

Primary Care Stroke Algorithm Tool 2008-10

Ian Stiell Ottawa Health Research Institute

Evaluation of the Implementation of the Revised Acute Stroke Medical Redirect Paramedic Protocol (ASMRPP) in Urban and Rural Settings of Eastern Ontario Sponsoring Organization

2008-10

Dina Brooks/ Nancy Salbach

University of Toronto Investigating the relationships between clinical and laboratory-based measures of exercise capacity and measures of physical activity in daily life in individuals post stroke

2009-11

Leanne Casaubon


Medical, rehabilitation and educational needs after stroke: a study of ethnic subgroups in Toronto

2009-11

Mary Egan University of Ottawa Measuring engagement in valued activities and its health benefits among stroke survivors living in long-term care facilities

2009-11

Peter Rosenbaum

McMaster University Exploring Client-Centred Care experiences of patients, families and health professionals in in-patient stroke rehabilitation settings: A mixed methods design

2009-11

Gustavo Saposnik

St. Michael's Hospital S.O.S. Stroke Care - Evaluating gaps along the continuum in stroke care

2009-11

Robert Teasell

Lawson Health Research Institute

An Economic Model for Stroke Rehabilitation in Ontario: Mapping Resource Availability and Patient Needs

2009-11

Gail MacKenzie

Hamilton Health Sciences Corporation

Tailored Interventions to Improve Hypertension Management After Stroke or TIA Study - Phase II (TIMS II)

2009-11

Krystyna Skrabka/ Jacqueline Willems

St. Michael's Hospital Effect of the Implementation of an Inpatient Code Stroke Protocol on Outcomes and Staff Knowledge

2009-11

Bruce Minore

Lakehead University Teach Our Children: Stroke Awareness for Aboriginal Youth

2009-11

Denyse Richardson

Toronto Rehabilitation Institute

The Effect of a Three-Dimensional Scapular-Humeral Mobilization Technique and Protocol on the reduction of Hemiplegic Shoulder Pain

2009-11

Ruth Hall/ Moira Kapral

Institute for Clinical Evaluative Studies

Stroke Prevention Clinic Database Evaluation Project 2009-11

Richard Swartz

Sunnybrook Health Sciences Centre

The “Weight Times” Strategy: A simple, low cost intervention to improve safety in patients receiving thrombolysis for acute stroke.

2010-12

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Funded

Julie Richardson/ Rebecca Fleck

School of Rehabilitation Science, McMaster University Central South Regional Stroke Network

FIT for FUNCTION:A Community Wellness Program for Persons with Stroke

2010-12


Exploring the influence of the adult daughter to stroke survivor relationship on caregiver wellbeing

2010-12


Linkage with the “Assessment for Living with Aphasia” to an economic Quality of Life Measure

2010-12

Gustavo Saposnik

St Michael’s Hospital,

Effectiveness of Virtual Reality Exercises in Stroke Rehabilitation (EVREST)

2010-12

Mark Bayley Toronto Rehabilitation Institute/University of Toronto

Current State of Community Stroke Support Services in Ontario

2010-12

Robert Teasell

St Joseph’s Health Care London/Lawson Health Research Institute and University of Western Ontario

Adherence to Canadian stroke rehabilitation guidelines regarding the assessment and treatment of post-stroke depression: a quality assurance initiative

2010-12

Gabrielle deVeber

The Hospital for Sick Children

Hemorrhage in Children with Cerebrovascular Malformations

2010-12

Gail Mores March of Dimes

A pilot study of the evaluation of the Family/Informal Caregiver Stroke Self-Management Project (FICSS): Impact on caregiver psychosocial, emotional and health needs

2010-12

David Gladstone

Sunnybrook Health Sciences Centre

The Ontario Stroke Prevention Registry for Atrial Fibrillation

2010-12

Elizabeth Inness/ Avril Mansfield

Toronto Rehabilitation Institute

Do measures of reactive balance control predict falls in people with stroke returning to the community?

2010-12

Vince DePaul McMaster University and Physiotherapy Department(St Joseph’s Healthcare Hamilton)

Impact of physical guidance schedule on learning of a challenging walking task in adults with a history of stroke: a pilot project

2010-12

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APPENDIX F

2010 OSN RESEARCH BOARD AND OSN RESEARCH COMMITTEE MEMBERSHIP

2010 OSN Research Board Membership

Malcolm Moffat (chair) Chris O’Callaghan, OSN Ilsa Blidner Sandra Ireland Mary Lewis Jim Sahlas Lori Marshall Adam Watson Darren Jermyn Sandra Black Mark Bayley Gabrielle deVeber Joann Trypuc Cally Martin

2010 OSN Research Committee Membership

Margaret Risk (chair) David Gladstone Gustavo Saposnik Jacqueline Willems Bev Powell-Vinden Sandra Ireland Chris O’Callaghan Linda Kelloway

ontario stroke network · each region has a regional stroke centre and many have district stroke...

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