Susan Rappolt

University of Toronto, Toronto, Ontario, Canada

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Publications (27)56.43 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper introduces an inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury. This guideline aims to explicate the processes and factors relevant to vocational evaluation to assist evaluators (i.e. health care teams, individuals and employers) in collaboratively determining if clients are able to work and to make recommendations for work entry, re-entry or vocational planning. Methods in the Canadian Medical Association's (CMA) Handbook on Clinical Practice Guideline and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were utilized to ensure rigour. Steps in the CMA handbook were followed and included: (1) identifying the guideline's objective and questions; (2) systematic literature review; (3) study selection and quality appraisal; (4) development of clear recommendations by key stakeholders; (5) guideline pilot testing and endorsement. The resulting guideline includes 17 key recommendations within the seven domains: (1) evaluation purpose and rationale; (2) initial intake process; (3) assessment of the personal domain; (4) assessment of the environment; (5) assessment of occupational/job requirements; (6) analysis and synthesis; (7) evaluation recommendations. The guideline may be useful to individually practicing clinicians, health care teams, employers and individuals with TBI. Future research will formally examine the success of the guideline's implementation.
    Journal of Occupational Rehabilitation 10/2011; 22(2):166-81. · 2.80 Impact Factor
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    ABSTRACT: This paper is a qualitative synthesis of clients' perspectives of the elements significant to return to work following traumatic brain injury (TBI). This is part of a larger review, completed to provide the evidence base for a vocational evaluation guideline. Processes outlined in the Cochrane Handbook of Systematic Review guided the full review including: developing review questions, search strategies and selection criteria; quality appraisal; data extraction, analysis and synthesis; drawing conclusions. Four data bases (i.e. Medline, Embase, PsychInfo, Cochrane) were searched for relevant qualitative studies. Evidence tables were used to extract data from studies and thematic analysis employed to analyze the qualitative data. Analysis of clients' perspectives on return to work resulted in four key themes including the following: 1) meaning of work; 2) process of return to work and reconciling new identities; 3) opportunities to try versus risks of failure; 4) significance of supports. Themes are discussed in relation to vocational evaluation and findings from other syntheses. Vocation evaluation should include the assessment of: the meaning clients ascribe to work following a TBI and their post-injury goals; clients' self-perceptions of work competency, work readiness and anticipated challenges with return to work; and the available supports.
    Disability and Rehabilitation 09/2011; 34(3):179-88. · 1.54 Impact Factor
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    ABSTRACT: In order to develop the evidence base for a clinical practice guideline (CPG) for vocational evaluation following traumatic brain injury (TBI), we undertook a review to identify the key processes evaluators should follow and the key factors they should consider when completing a vocational evaluation. Processes outlined in the Cochrane Handbook of Systematic Review guided our processes and included: development of review questions, search strategies and selection criteria; quality appraisal; extraction, analysis and data synthesis; drawing conclusions. Four data bases (i.e. Medline; PsychInfo; Embase; The Cochrane Library of Systematic Reviews) were searched for descriptive articles, quantitative and qualitative studies, and nine websites were searched for CPGs (e.g. Scottish Intercollegiate Guideline Network; US National Guideline Clearinghouse; New Zealand Guideline Group). Two reviewers independently appraised methodological quality. Data were extracted into evidence tables which included: study purpose; location; participants; design/method; themes; findings; relevant processes and factors. Directed content analysis was utilized to analyze and synthesize the descriptive process evidence. A constant comparative method was employed to compare study findings in relation to factors associated with successful employment. Results from process and factors syntheses are integrated into the Evidence-based Framework for Vocational Evaluation Following TBI. This framework identifies seven key processes in a vocational evaluation, including: (1) identification of the evaluation purpose and rationale; (2) intake process; (3) assessment of the person; (4) assessment of the environment; (5) assessment of the occupation/job requirements; (6) analysis and synthesis of assessment results; (7) development of evaluation recommendations. Relevant factors are integrated into each key process. This framework outlines the key information evaluators should gather, the domains of the person, environment and occupation they should assess, and elements of rigour they should consider when completing a vocational evaluation and making recommendations for work re-entry following a TBI.
    Journal of Occupational Rehabilitation 01/2011; 21(3):374-94. · 2.80 Impact Factor
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    ABSTRACT: Using a multiple case study design, this article explores the translation process that emerges within Ontario long-term care (LTC) homes with the adoption and implementation of evidence-based clinical practice guidelines (CPGs). Within-organization knowledge translation is referred to as knowledge application. We conducted 28 semi-structured interviews with a range of administrative and care staff within 7 homes differentiated by size, profit status, chain membership, and rural/urban location. We further undertook 7 focus groups at 5 locations, involving a total of 35 senior clinical staff representing 15 homes not involved in earlier structured interviews. The knowledge application process that emerges across our participant organizations is highly complex, iterative, and reliant upon a facility's knowledge application capacity, or absorptive capacity to effect change through learning. Knowledge application capacity underpins the emergence of the application process and the advancement of knowledge through it. We find that different elements of capacity are important to different stages of the knowledge application process. Capacity can pre-exist, or can be acquired. The majority of the capacity elements required for successful knowledge application in the LTC contexts we studied were organizational. It is essential for managers and practitioners therefore to conceptualize and orchestrate knowledge application initiatives at the organization level; organizational leaders (including clinical leaders) have a vital role to play in the success of knowledge application processes.
    Social Science [?] Medicine 02/2010; 70(9):1326-34. · 2.73 Impact Factor
  • Archives of Physical Medicine and Rehabilitation - ARCH PHYS MED REHABIL. 01/2010; 91(10).
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    ABSTRACT: Despite occupational therapists' role in work-related evaluations, there are no guidelines for evaluating clients' work readiness. This study explored how occupational therapists evaluate work readiness following acquired brain injury in order to develop an integrated model of the factors, processes, stakeholders, and contextual elements relevant to this evaluation. Ten occupational therapists with expertise in vocational and brain injury rehabilitation were interviewed. Data were analyzed using grounded theory methods to develop the work readiness evaluation model. This model describes five processes formative to therapists' evaluation: (1) drawing upon diverse sources of information and perspectives; (2) assessing occupational capacity; (3) contextualizing occupational potential; (4) building a shared understanding of work readiness among stakeholders, including, clients, employers, insurers, and rehabilitation teams; and (5) transforming the work readiness question. The model highlights the importance of building a shared understanding amongst stakeholders and provides a provisional framework to guide practice.
    Canadian Journal of Occupational Therapy 10/2009; 76(4):276-84. · 0.69 Impact Factor
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    ABSTRACT: Little is known about physical therapists' experiences using research evidence to improve the delivery of stroke rehabilitation. The purpose of this study was to explore how physical therapists use research evidence to update the clinical management of walking rehabilitation after stroke. Specific objectives were to identify physical therapists' clinical questions related to walking rehabilitation, sources of information sought to address these questions, and factors influencing the incorporation of research evidence into practice. Two authors conducted in-depth telephone interviews with 23 physical therapists who treat people with stroke and who had participated in a previous survey on evidence-based practice. Data were analyzed with a constant comparative approach to identify emerging themes. Therapists commonly raised questions about the selection of treatments or outcome measures. Therapists relied foremost on peers for information because of their availability, ease of access, and minimal cost. Participants sought information from research literature themselves or with the help of librarians or students. Research syntheses (eg, systematic reviews) enabled access to a body of research. Older therapists described insufficient computer and search skills. Most participants considered appraisal and application of research findings challenging and identified insufficient time and peer isolation as organizational barriers to the use of research. Physical therapists require efficient access to research syntheses primarily to inform the measurement and treatment of walking limitation after stroke. Continuing education is needed to enhance skills in appraising research findings and applying them to practice. Older therapists require additional training to develop computer and search skills. Peer networks and student internships may optimize the exchange of new knowledge for therapists working in isolation.
    Physical Therapy 04/2009; 89(6):556-68. · 2.78 Impact Factor
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    ABSTRACT: A qualitative meta-synthesis is an approach to synthesizing relevant findings from across qualitative studies on a particular topic using methods consistent with qualitative research. Using examples of recently completed qualitative meta-synthesis projects, the purpose of this paper is to present the meta-synthesis approach; highlight the key steps, processes, and issues involved; and demonstrate its potential to advance knowledge about occupation and occupation-based practice. The qualitative meta-synthesis approach allows us to take stock of the current state of knowledge in a given area in order to ensure that we have explored the phenomenon from different perspectives and to begin to push the field forward by allowing us to develop deeper insights and understandings. Despite certain limitations and challenges associated with the approach, qualitative meta-syntheses can provide new knowledge through critical analysis and interpretation to inform client, practitioner, and policy audiences.
    Canadian Journal of Occupational Therapy 01/2009; 75(5):301-8. · 0.69 Impact Factor
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    David Coburn, Susan Rappolt, Ivy Bourgeault
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    ABSTRACT: Abstract Abstract Though some argue that medical power is declining, others disagree. In particular, Freidson assets that medicine is being restratified with medical elites retaining control over health care though practitioners are losing their individual autonomy to these elites. We use the case of state-medicine relationships in Ontario to examine the restratification thesis. Our findings indicate that the state partially controls medicine through restratification. There is partial state co-option of medical organisations and elites. This case also implies that control over the context of care and over the content of medical practice is not as separate as assumed, that profession-practitioner relationships are increasingly problematic, that the concept of autonomy itself requires theoretical and empirical specification, and that the existence of self-regulatory and representative organisations cannot be equated with actual professional self-regulation. The contingent nature of medical power is underlined.
    Sociology of Health & Illness 06/2008; 19(1):1 - 22. · 1.88 Impact Factor
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    ABSTRACT: Within the context of knowledge translation, the disconnect between the results of research and the practice patterns of nursing care providers has not been reported in the context of institutional dementia care practice. Therefore, little is known about how knowledge about best dementia care practice, defined broadly as the person-centered approach, gets used by institutional nursing care providers. Unregulated care providers provide the majority of nursing care for older people with Alzheimer's disease and related disorders living in long-term care facilities. The purpose of this grounded theory study was to explore the process whereby these workers use knowledge about person-centered care in their dementia care practice. Transcribed data from tape-recorded interviews with 20 unregulated care providers among eight long-term care facilities in Ontario, Canada, were coded and categorized at progressively more abstract levels until concepts and the relationships among them were integrated in a middle-range theory of knowledge utilization. The theory of Figuring it Out in the Moment illustrates how unregulated care providers in dementia care settings practice in the context of unpredictability, variability, and personal threat. Their use of knowledge about person-centered care is dependent on the existence of certain individual and relational conditions that interrelate with four separate, but interconnected, phases of clinical decision-making and action. As a middle-range theory, Figuring it Out in the Moment is concrete and pragmatic information for promoting evidence-based dementia care not included in existing overarching knowledge utilization frameworks. Areas for further investigation include how knowledge utilization is conceptualized, as well as the influences of practitioners' clinical decision-making, the nature of caregiving with particular client populations, and the characteristics of individuals alone and in relationship on the utilization of best practice knowledge.
    Worldviews on Evidence-Based Nursing 02/2008; 5(1):13-24. · 1.35 Impact Factor
  • Mary Stergiou-Kita, Susan Rappolt
    Archives of Physical Medicine and Rehabilitation - ARCH PHYS MED REHABIL. 01/2008; 89(10).
  • Mary Stergiou-Kita, Susan Rappolt
    Archives of Physical Medicine and Rehabilitation - ARCH PHYS MED REHABIL. 01/2008; 89(10).
  • Source
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    ABSTRACT: The purpose of this study was to identify practitioner barriers (education, attitudes and beliefs, interest and perceived role, and self-efficacy) and organizational barriers (perceived support and resources) to physical therapists' implementation of evidence-based practice (EBP) for people with stroke. The participants were 270 physical therapists providing services to people with stroke in Ontario, Canada. A cross-sectional mail survey was conducted. Only half of respondents had learned the foundations of EBP in their academic preparation or received training in searching or appraising research literature. Although 78% agreed that research findings are useful, 55% agreed that a divide exists between research and practice. Almost all respondents were interested in learning EBP skills; however, 50% indicated that physical therapists should not be responsible for conducting literature reviews. Average self-efficacy ratings were between 50% and 80% for searching and appraising the literature and below 50% for critically appraising psychometric properties and understanding statistical analyses. Despite Internet access at work for 80% of respondents, only 8% were given protected work time to search and appraise the literature. Lack of education, negative perceptions about research and physical therapists' role in EBP, and low self-efficacy to perform EBP activities represent barriers to implementing EBP for people with stroke that can be addressed through continuing education. Organizational provision of access to Web-based resources is likely insufficient to enhance research use by clinicians.
    Physical Therapy 11/2007; 87(10):1284-303. · 2.78 Impact Factor
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    ABSTRACT: To assess radiation oncology residents' needs and satisfaction in their first postgraduate year (PGY-1) in the province of Ontario. Of 62 radiation oncology residents, 58 who had completed their PGY-1 and were either enrolled or had graduated in 2006 were invited to participate in a 31-item survey. The questionnaire explored PGY-1 residents' needs and satisfaction in four domains: clinical workload, faculty/learning environment, stress level, and discrimination/harassment. The Fisher's exact and Wilcoxon nonparametric tests were used to determine relationships between covariate items and summary scores. Of 58 eligible residents, 44 (75%) responded. Eighty-four percent of residents felt that their ward and call duties were appropriate. More than 50% of respondents indicated that they often felt isolated from their radiation oncology program. Only 77% agreed that they received adequate feedback, and 40% received sufficient counseling regarding career planning. More than 93% of respondents thought that faculty members had contributed significantly to their learning experience. Approximately 50% of residents experienced excessive stress and inadequate time for leisure or for reading the medical literature. Less than 10% of residents indicated that they had been harassed or experienced discrimination. Eighty-three percent agreed or strongly agreed that their PGY-1 experience had been outstanding. Most Ontario residents were satisfied with their PGY-1 training program. More counseling by radiation oncology faculty members should be offered to help residents with career planning. The residents might also benefit from more exposure to "radiation oncology" and an introduction to stress management strategies.
    International Journal of Radiation OncologyBiologyPhysics 11/2007; 69(2):512-7. · 4.52 Impact Factor
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    ABSTRACT: Although the use of reflection to facilitate learning and its application in practice has been widely advocated, there is little empirical research to establish whether or not health professionals use reflection to integrate learning into clinical practice. Particularly troublesome is the lack of empirically based theory underlying strategies to promote reflection and understand factors that influence its use in translating learning into practice. Occupational therapists participated in this case study, in which reflection and implementation of learning from a short course into practice were examined using a multimethod approach. In phase one (n = 41), quantitative data were collected from a practice survey, the Self-Reflection and Insight Scale (SRIS) and Commitment to Change (CTC) statements. In phase two (n = 33), follow-up CTC data were collected to quantify the extent of achievement of CTCs. Data from phases one and two were analyzed descriptively to inform the selection of interview participants (n = 10) in phase three of data collection. Two models were generated. One model describes when reflection was used, and the second model explains factors influencing its use. Participants used reflection before, during, and after the course, and reflection was influenced by a range of factors associated with the course, practice context, and the individual. The theory and models depicting the use of reflection may guide educators' use of reflective learning before, during, and after short courses.
    Journal of Continuing Education in the Health Professions 02/2007; 27(3):143-8. · 1.32 Impact Factor
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    ABSTRACT: The Ontario Stroke System was developed to enhance the quality and continuity of stroke care provided across the care continuum. To identify the role evidence played in the development and implementation of the Ontario Stroke System. This study employed a qualitative case study design. In-depth interviews were conducted with six members of the Ontario Stroke System provincial steering committee. Nine focus groups were conducted with: Regional Program Managers, Regional Education Coordinators, and seven acute care teams. To supplement these findings interviews were conducted with eight individuals knowledgeable about national and international models of integrated service delivery. Our analyses identified six themes. The first four themes highlight the use of evidence to support the process of system development and implementation including: 1) informing system development; 2) mobilizing governmental support; 3) getting the system up and running; and 4) integrating services across the continuum of care. The final two themes describe the foundation required to support this process: 1) human capacity and 2) mechanisms to share evidence. This study provides guidance to support the development and implementation of evidence-based models of integrated service delivery.
    International journal of integrated care 02/2007; 7:e30. · 1.30 Impact Factor
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    ABSTRACT: Studies of health professionals' perceptions of barriers to and facilitators of research utilization in clinical practices suggest that structural and resource characteristics of service provider organizations are key determinants of the capacity of individual practitioners to provide evidence-based practices. In this pilot study, we compare health professionals' self-reported practice changes with characteristics of the structures and resources available to support research use at 4 hospitals. Data on the self-reported practice changes of stroke rehabilitation professionals at Ontario hospitals were analyzed following their participation in a mentored online educational intervention, the Rehabilitation Education Program for Stroke (REPS). In-depth interviews with a purposefully drawn subsample of REPS mentors and managers of stroke rehabilitation programs examined the participating hospitals' structural and resource characteristics. The interview data on hospital characteristics were coded descriptively and thematically, quantified, and then compared with the percentage of individual REPS participants who reported positive practice changes in each hospital. Hospitals with higher percentages of participants reporting improved practices following REPS provided better computer access, paid time to participate in REPS, had established specialized units of stroke care, strong teamwork, and were previously committed to implementing best practices. They also conducted program audits or evaluations and engaged in "bottom-up" program decision making. Continuing educators should consider the capacity of hospitals to support practice changes when planning educational interventions for rehabilitation professionals. Larger studies employing objective measures are needed to examine relationships between practice improvements and organizational characteristics following educational interventions.
    Journal of Continuing Education in the Health Professions 02/2005; 25(2):116-24. · 1.32 Impact Factor
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    ABSTRACT: New research knowledge acquired from Web-based sources may have a better chance of being translated into practice when accompanied by additional educational strategies. This study was undertaken to investigate that hypothesis. The Rehabilitation Education Program for Stroke (REPS) combines a self-directed online learning module with support from peer mentors, technical skills workshops, and organizational supports. Participants completed learning tests and practice surveys before and after the program and at a 6-month follow-up. Learning and self-reported practice outcomes improved in the areas of assessment, client-centered practice, support for family and caregivers, and detecting depression. Participants also identified and reported specific strategies for individual and programmatic practice change. A multifaceted, interdisciplinary online education intervention can positively influence stroke rehabilitation practices.
    Journal of Continuing Education in the Health Professions 02/2005; 25(2):105-15. · 1.32 Impact Factor
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    ABSTRACT: Many health professionals, including occupational therapists, have difficulty utilizing research findings in daily practice. To determine if an online action research project could enhance research use among occupational therapists working in similar practice areas. Four groups of 12-14 occupational therapists met online for approximately one year. They discussed barriers and facilitators to research utilization, defined practice questions, and attempted to search for, synthesize and apply relevant research findings. Online communications and post-group interviews were thematically analyzed. Only half of the participants who began the project were still online with the research project at completion. These participants believed that their involvement in the group led to increased personal awareness, motivation and confidence regarding the use of research evidence in practice and knowledge to be used in practice. Time to review, critique and synthesize research evidence continued to be a major barrier to enhanced research utilization. Online meetings designed to enhance research use among occupational therapists appear to hold some promise, but refinements are needed to ensure their ultimate success.
    Canadian Journal of Occupational Therapy 11/2004; 71(4):230-7. · 0.69 Impact Factor
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    Janet Craik, Susan Rappolt
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    ABSTRACT: There is a pressing need for occupational therapists to provide research-based practice, yet there is little understanding of the specific strategies and processes individual practitioners use to integrate research evidence into their clinical practice. Using grounded theory method, the self-reported research utilization strategies of a sample of 11 elite occupational therapists practicing in adult stroke rehabilitation were examined. The triangulation of the interview data, the organizational policies of their workplaces, and existing theoretical concepts and processes of research utilization resulted in the development of a theory and a practice model to guide research utilization in occupational therapy. The Theory of Research Utilization Enhancement for Occupational Therapists, and the Model of Research Utilization in Occupational Therapy are presented, and their implications for practice, policy, education and future research are discussed. Built upon the Occupational Performance Process Model, the theory and model are proposed as guides to enhance therapists' ability to maintain a client-centred approach while informing clinical practices with research evidence. The application of structured reflection, case application and peer consultation facilitate the integration of research evidence into clinical practices.
    Canadian Journal of Occupational Therapy 01/2004; 70(5):266-75. · 0.69 Impact Factor

Publication Stats

601 Citations
56.43 Total Impact Points

Institutions

  • 2002–2011
    • University of Toronto
      • • Department of Rehabilitation Science
      • • Faculty of Medicine
      • • Department of Occupational Science and Occupational Therapy
      Toronto, Ontario, Canada
  • 2008
    • West Park Healthcare Centre
      Toronto, Ontario, Canada
  • 2007
    • Sunnybrook Health Sciences Centre
      • Department of Radiation Oncology
      Toronto, Ontario, Canada