The Interface of Clinical Decision-Making With Study Protocols for Knowledge Translation From a Walking Recovery Trial.
The Interface of Clinical Decision-Making With Study Protocols for Knowledge Translation From a Walking Recovery Trial.
复制标题
DOI：
10.1097/npt.0000000000000158
复制
发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Behrman AL
中科院分区：
文献类型：
--
作者：
Hershberg JA;Rose DK;Tilson JK;Brutsch B;Correa A;Gallichio J;McLeod M;Moore C;Wu S;Duncan PW;Behrman AL
尽管努力将知识转化为临床实践，但在将随机对照试验（RCT）的严格协议适应个体患者时，往往会出现障碍。卒中后运动体验应用（LEAPS）随机对照试验显示两种干预方案对卒中后步行恢复的效果相同；两种方案都比常规护理物理治疗更有效。本文的目的是提供知识翻译工具，以促进LEAPS RCT协议在临床实践中的实施。来自两个试验干预组的参与者：1)早期运动训练计划（LTP）和2)家庭运动计划（HEP）被选择进行病例报告。这些案例说明了这些方案是如何与个体患者的陈述和临床专业知识协同使用的：RCT标准化干预方案的实施与临床决策之间的接口。在每种情况下，参与者都提出了不同的临床挑战，治疗师通过将参与者的独特陈述与治疗师的专业知识相结合来解决这些挑战，同时保持对LEAPS协议的忠诚。两位参与者都经历了越来越具有挑战性的干预，尽管他们有自己独特的表现。两种协议的决策算法和练习进度都以易于实现的格式提出。这些案例通过加强对方案、进展及其在个体参与者中的应用的理解，促进了LEAPS RCT转化为临床实践。
Despite efforts to translate knowledge into clinical practice, barriers often arise in adapting the strict protocols of a randomized, controlled trial (RCT) to the individual patient. The Locomotor Experience Applied Post-Stroke (LEAPS) RCT demonstrated equal effectiveness of two intervention protocols for walking recovery post stroke; both protocols were more effective than usual care physical therapy. The purpose of this manuscript is to provide knowledge-translation tools to facilitate implementation of the LEAPS RCT protocols in clinical practice. Participants from two of the trials’ intervention arms: 1) early Locomotor Training Program (LTP) and 2) Home Exercise Program (HEP) were chosen for case presentation. The cases illustrate how the protocols are used in synergy with individual patient presentations and clinical expertise: the interface between implementation of an RCT standardized intervention protocol and clinical decision-making. In each case, the participant presents with a distinct clinical challenge that the therapist addresses by integrating the participant’s unique presentation with the therapist’s expertise while maintaining fidelity to the LEAPS protocol. Both participants progressed through an increasingly challenging intervention despite their own unique presentation. Decision algorithms and exercise progression for both protocols are presented in an easy to implement format. These case examples facilitate translation of the LEAPS RCT into clinical practice by enhancing understanding of the protocols, their progression, and their application to individual participants.