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A retrospective analysis of a clinician-initiated high-intensity locomotor training implementation project in an inpatient rehabilitation facility.

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Název: A retrospective analysis of a clinician-initiated high-intensity locomotor training implementation project in an inpatient rehabilitation facility.
Autoři: Tapp A; Department of Graduate Studies in Health and Rehabilitation, Youngstown State University, Youngstown, OH, USA., Dray D; Department of Rehabilitation, Mercy Health St. Elizabeth's Hospital, Youngstown, OH, USA., Griswold D; Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA., Haybarger R; Department of Rehabilitation, Mercy Health St. Elizabeth's Hospital, Youngstown, OH, USA., Learman K; Department of Graduate Studies in Health and Rehabilitation, Youngstown State University, Youngstown, OH, USA.
Zdroj: Physiotherapy theory and practice [Physiother Theory Pract] 2025 Jul; Vol. 41 (7), pp. 1378-1387. Date of Electronic Publication: 2024 Nov 05.
Způsob vydávání: Journal Article
Jazyk: English
Informace o časopise: Publisher: Informa Healthcare Country of Publication: England NLM ID: 9015520 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-5040 (Electronic) Linking ISSN: 09593985 NLM ISO Abbreviation: Physiother Theory Pract Subsets: MEDLINE
Imprint Name(s): Publication: London : Informa Healthcare
Original Publication: London, UK ; Hillsdale, N.J. : Lawrence Erlbaum Associates, c1990-
Výrazy ze slovníku MeSH: Stroke Rehabilitation*/methods , Exercise Therapy*/methods , Rehabilitation Centers*, Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Aged ; Inpatients ; Recovery of Function ; Treatment Outcome ; Time Factors ; Walking
Abstrakt: Background: The Academy of Neurologic Physical Therapy's Intensity Matters campaign recommends the implementation of high-intensity locomotor training for all patients with neurologic dysfunction with goals to improve walking.
Objective: Retrospectively determine the effectiveness of a clinician-initiated implementation project on the adoption, reach, and fidelity of high-intensity locomotor training for patients with stroke during inpatient rehabilitation and, determine whether the project led to changes in patient outcomes.
Methods: Retrospective analysis of electronic medical records from 1 year before and after the project. Patients admitted with a stroke diagnosis were included. Demographic information, the number of high-intensity sessions, the percentage of time spent in the target heart rate zone, standardized assessment scores for motor function, functional mobility, balance, gait speed and endurance, and discharge destination were extracted for descriptive and linear mixed model analysis.
Results: Clinician reach was 75%, and adoption of high-intensity training varied between clinicians from 47.1% and 83.3%. Of eligible patients, 55% received the target intervention at least once, reflecting the patient reach. Implementation fidelity was 18.84%. Linear mixed effects modeling revealed a statistically significant effect of time ( p  < .001) but not group allocation or group × time interaction.
Conclusions: Although statistically significant differences in patient outcomes compared to pre-implementation were not found, results highlight the limitations associated with adopting high-intensity locomotor training for patients post-stroke in this setting .It remains unclear whether the implementation fidelity achieved was sufficient to impact patient outcomes. Further research is needed to establish fidelity targets and identify barriers to successful implementation projects by clinicians.
Contributed Indexing: Keywords: Stroke; gait; high-intensity; implementation
Entry Date(s): Date Created: 20241105 Date Completed: 20250624 Latest Revision: 20250624
Update Code: 20250624
DOI: 10.1080/09593985.2024.2424354
PMID: 39499204
Databáze: MEDLINE
Popis
Abstrakt:Background: The Academy of Neurologic Physical Therapy's Intensity Matters campaign recommends the implementation of high-intensity locomotor training for all patients with neurologic dysfunction with goals to improve walking.<br />Objective: Retrospectively determine the effectiveness of a clinician-initiated implementation project on the adoption, reach, and fidelity of high-intensity locomotor training for patients with stroke during inpatient rehabilitation and, determine whether the project led to changes in patient outcomes.<br />Methods: Retrospective analysis of electronic medical records from 1 year before and after the project. Patients admitted with a stroke diagnosis were included. Demographic information, the number of high-intensity sessions, the percentage of time spent in the target heart rate zone, standardized assessment scores for motor function, functional mobility, balance, gait speed and endurance, and discharge destination were extracted for descriptive and linear mixed model analysis.<br />Results: Clinician reach was 75%, and adoption of high-intensity training varied between clinicians from 47.1% and 83.3%. Of eligible patients, 55% received the target intervention at least once, reflecting the patient reach. Implementation fidelity was 18.84%. Linear mixed effects modeling revealed a statistically significant effect of time ( p  &lt; .001) but not group allocation or group × time interaction.<br />Conclusions: Although statistically significant differences in patient outcomes compared to pre-implementation were not found, results highlight the limitations associated with adopting high-intensity locomotor training for patients post-stroke in this setting .It remains unclear whether the implementation fidelity achieved was sufficient to impact patient outcomes. Further research is needed to establish fidelity targets and identify barriers to successful implementation projects by clinicians.
ISSN:1532-5040
DOI:10.1080/09593985.2024.2424354