Integrating De-Implementation and Implementation to Advance Evidence-Based Stroke Rehabilitation - PROJECT SUMMARY The K01 Mentored Research Scientist Development Award will support Dr. Jessica Edelstein’s transition to an independent investigator in implementation science, focused on advancing evidence-based occupational therapy and stroke rehabilitation. Her mentorship team includes nationally recognized experts in implementation science and rehabilitation (Dr. Miriam Rafferty, primary mentor), de-implementation and pragmatic evaluation methods (Dr. Virginia McKay, co-mentor), stroke rehabilitation research, biostatistics, and research management. With this multidisciplinary guidance, Dr. Edelstein will integrate implementation science principles and methods into her established health services research program, moving from identifying gaps in care delivery to developing solutions that promote evidence-based rehabilitation. Outdated rehabilitation approaches, such as neuro-development treatment (NDT), remain pervasive in stroke rehabilitation despite strong evidence supporting evidence-based alternatives like task-specific training (TST). To address this, the project takes a novel dual focus on de-implementation and implementation, identifying, co- designing, and pilot-testing strategies to reduce NDT use and increase TST delivery within inpatient stroke rehabilitation. This integrated approach will generate actionable strategies that directly improve the quality and consistency of rehabilitation care. Aim 1 will identify barriers and facilitators to de-implementing NDT and increasing TST through documentation audits, clinical observation, focus groups, surveys, and interviews. Aim 2 will co-design strategies to de-implement NDT and implement TST using therapist- and advisor-led structured discussions to prioritize feasible, clinically-applicable strategies. Aim 3 will explore the preliminary effectiveness and feasibility of de-implementation and implementation strategies on two inpatient stroke rehabilitation units, evaluating their impact on NDT and TST delivery using clinical observations, documentation audits, and surveys. Together, the research and career development plan will equip Dr. Edelstein with the advanced conceptual, methodological, and leadership skills to establish an independent program of research focused on developing, testing, and scaling evidence-based rehabilitation delivery models, advancing both implementation and de- implementation science to improve patient outcomes and system efficiency.
