Implementation and evaluation of the Graded Repetitive Arm Supplementary Program (GRASP) for people with stroke in a real-world community setting : Case Report

Objective: Exercise programs to improve upper extremity function following stroke in the community setting are needed as the length of hospital stay continues to reduce. However, little has been done to understand how to translate an evidence-based rehabilitation intervention to real-world programs. The purpose of the study is to undertake a process evaluation of the implementation of an evidence-based upper extremity rehabilitation intervention for stroke, the Graded Repetitive Arm Supplementary Program (GRASP), in a community setting. Case Description: A partnership between a nonprofit support organization and a local community center was established to deliver the program in the community. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework with mixed methods was used to evaluate the implementation. Results: REACH: Twenty people were screened, 14 people were eligible, and 13 consented to participate in the study. The program reached approximately 1.25 % of the potential target population. EFFECTIVENESS: Stroke participants demonstrated significant improvement in upper extremity function and quality of life as measured by the Fugl-Meyer Upper Extremity Scale, Action Research Arm Test, Rating of Everyday Arm-use in the Community and Home Scale, and Stroke Impact Scale. ADOPTION: Factors that facilitate program uptake were well planned implementation and the workplace coaching based on the audit results. Factors contributing to ongoing participation were the social support within the group environment and the instructor’s capability of engaging the group. IMPLEMENTATION: A partnership between a nonprofit organization and a local community center was established successfully. The program was implemented as intended as verified by a fidelity checklist. Participants’ adherence was high as confirmed by the average attendance and practice time. MAINTENANCE: Both the partner organization and community center continued to offer the program. Conclusion: The program had good fidelity of the critical principles and core components, and was effective in improving upper extremity function and quality of life. This partnership model may serve as the first step for future larger-scale implementation and can be used to move other stroke rehabilitation interventions into community settings.Medicine, Faculty ofPhysical Therapy, Department ofReviewedFacultyPostdoctora