Team training and stroke rehabilitation outcomes: a cluster randomized trial

Arch Phys Med Rehabil. 2008 Jan;89(1):10-5. doi: 10.1016/j.apmr.2007.08.127.


Objective: To test whether a team training intervention in stroke rehabilitation is associated with improved patient outcomes.

Design: A cluster randomized trial of 31 rehabilitation units comparing stroke outcomes between intervention and control groups.

Setting: Thirty-one Veterans Affairs medical centers.

Participants: A total of 237 clinical staff on 16 control teams and 227 staff on 15 intervention teams. Stroke patients (N=487) treated by these teams before and after the intervention.

Intervention: The intervention consisted of a multiphase, staff training program delivered over 6 months, including: an off-site workshop emphasizing team dynamics, problem solving, and the use of performance feedback data; and action plans for process improvement; and telephone and videoconference consultations. Control and intervention teams received site-specific team performance profiles with recommendations to use this information to modify team process.

Main outcome measures: Three patient outcomes: functional improvement as measured by the change in motor items of the FIM instrument, community discharge, and length of stay (LOS).

Results: For both the primary (stroke only) and secondary analyses (all patients), there was a significant difference in improvement of functional outcome between the 2 groups, with the percentage of stroke patients gaining more than a median FIM gain of 23 points increasing significantly more in the intervention group (difference in increase, 13.6%; P=.032). There was no significant difference in LOS or rates of community discharge.

Conclusions: Stroke patients treated by staff who participated in a team training program were more likely to make functional gains than those treated by staff receiving information only. Team based clinicians are encouraged to examine their own team. ( identifier NCT00237757).

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Female
  • Hospitals, Veterans / organization & administration
  • Hospitals, Veterans / standards*
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care*
  • Patient Care Team*
  • Problem Solving
  • Recovery of Function
  • Stroke Rehabilitation*
  • United States
  • United States Department of Veterans Affairs

Associated data