Скачать или смотреть Development and Results of an Implementation Plan for High-Intensity Gait Training

Purpose: High-intensity gait training (HIT) is a recommended intervention for individuals with stroke who are undergoing gait rehabilitation. Research indicates that effectively implementing interventions into clinical practice is a challenge. This presentation will describe an overview of the development of an implementation plan for HIT, present implementation results, and identify the impact of implementing this intervention on clinicians and the health system.
Number of Subjects: Two inpatient rehabilitation facilities, including nine physical therapists, collaborated with a knowledge translation center to implement this program. Clinical and fidelity data were collected during stroke rehabilitation usual care (n=56) and after implementation of HIT (n=54).
Materials and Methods: We developed an implementation plan using the Knowledge-to-Action Framework. The Consolidated Framework for Implementation Research was used to identify barriers and select implementation strategies. Using mix-methods research, including surveys and informal discussions, we evaluated current practice, barriers, outcomes, and the sustainability of high-intensity gait training in practice. Fidelity measures included stepping amounts, peak heart rate, and time in the target heart rate zone.
Results: A multi-component implementation plan with 26 implementation strategies to target barriers was developed. Clinicians reported that usual care interventions to improve walking included a combination of balance, strength training, and gait interventions. Barriers to using HIT in routine practice included knowledge, beliefs, HIT adaptability, resources, and culture. Surveys and informal discussions identified significant changes in perceived practice, HIT adoption, and positive impacts on the health system. Following implementation, the average steps per day was significantly greater than during usual care. The average peak heart rate during a HIT session was 79 beats per minute and an average of 34% of each session obtained the target heart rate zone. The 2-year follow-up survey confirmed the sustainability of HIT in practice.
Conclusions: A multi-component implementation plan that targeted barriers resulted in the successful implementation of HIT in clinical practice.
Clinical Relevance: The use of implementation frameworks and a multi-component implementation strategy may increase the effectiveness of clinical implementation projects.