Development and Results of an Implementation Plan for High-Intensity Gait Training.
Development and Results of an Implementation Plan for High-Intensity Gait Training.
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DOI：
10.1097/npt.0000000000000364
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发表时间：
2021-10-01
期刊：
影响因子：
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通讯作者：
Nordvik JE
中科院分区：
文献类型：
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作者：
Moore JL;Bø E;Erichsen A;Rosseland I;Halvorsen J;Bratlie H;Hornby TG;Nordvik JE
补充数字内容在文本中可用。高强度的步态训练被推荐用于脑卒中康复，以提高步态速度、步行距离和平衡能力。然而，确定有效和高效的实施方法对康复服务提供者来说是一项挑战。本文介绍了一个实施计划的发展，提出了每个实施阶段的调查结果，并确定该项目对临床医生和卫生系统的影响。两个住院康复设施，包括9名物理治疗师，与知识翻译中心合作实施这一计划。我们使用知识到行动框架制定了实施计划，并利用实施研究综合框架来确定障碍和选择实施战略。使用混合方法研究，包括调查和非正式讨论，我们评估了目前的实践，障碍，结果和高强度步态训练在实践中的可持续性。制定了一项针对障碍的多部分执行计划。在实施之前，临床医生报告提供了几种平衡，力量训练和步态干预来改善行走。使用高强度步态训练的障碍包括知识，信念，高强度步态训练的适应性，资源，文化等。针对这些障碍选择了26项实施战略。调查和非正式讨论确定了感知实践的重大变化，高强度步态训练的采用以及对卫生系统的积极影响。2年的随访调查表明，新的做法是持续的。使用针对障碍物的多组件实施计划，我们成功地在临床实践中实施了高强度步态训练。成功实施的贡献者可能包括实施方法，通常的护理干预和临床医生对这种变化的准备。视频摘要可从作者获得更多见解（参见视频，补充数字内容1，可在http：//links.lww.com/JNPT/A352上获得。）
Supplemental Digital Content is Available in the Text. High-intensity gait training is recommended in stroke rehabilitation to improve gait speed, walking distance, and balance. However, identifying effective and efficient implementation methods is a challenge for rehabilitation providers. This article describes the development of an implementation plan, presents findings of each implementation phase, and identifies the project's impact on clinicians and the health system. Two inpatient rehabilitation facilities, including 9 physical therapists, collaborated with a knowledge translation center to implement this program. We developed an implementation plan using the Knowledge-to-Action Framework and utilized the Consolidated Framework for Implementation Research 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. A multicomponent implementation plan that targeted barriers was developed. Before implementation, clinicians reported providing several balance, strength training, and gait interventions to improve walking. Barriers to using high-intensity gait training included knowledge, beliefs, adaptability of high-intensity gait training, resources, culture, and others. Twenty-six implementation strategies were selected to target the barriers. Surveys and informal discussions identified significant changes in perceived practice, adoption of high-intensity gait training, and positive impacts on the health system. The 2-year follow-up survey indicated that the new practice was sustained. Using a multicomponent implementation plan that targeted barriers, we successfully implemented high-intensity gait training in clinical practice. Contributors to successful implementation may include the implementation methods, usual care interventions, and clinicians' readiness for this change. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A352.)