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Applying the Knowledge-to-Action Framework to Implement Gait and Balance Assessments in Inpatient Stroke Rehabilitation.

Jennifer L. Moore,Roberta Virva,Christopher E. Henderson,Lauren Lenca,J. Butzer,L. Lovell,Elliot Roth,I. Graham,T. Hornby

Published 2020 in Archives of Physical Medicine and Rehabilitation

ABSTRACT

OBJECTIVE The overall objectives of this project were to implement and sustain use of a gait assessment battery (GAB) that included the Berg Balance Scale, 10 Meter Walk Test, and 6 Minute Walk Test during inpatient stroke rehabilitation. The study objective was to assess the impact of the study intervention on clinician adherence to the recommendations and its impact on clinician perceptions and the organization. DESIGN Pre and post-training intervention study. SETTING Subacute inpatient rehabilitation facility. PARTICIPANTS Six Physical therapists and two physical therapist assistants. INTERVENTION The intervention comprised a bundle of activities including co-developing and executing the plan with clinicians and leaders. The multi-component implementation plan was based on the Knowledge-to-Action Framework, and included implementation facilitation, implementation leadership, and a bundle of knowledge translation interventions that targeted barriers. Implementation was an iterative process in which results from one implementation phase informed planning of the next phase. MAIN OUTCOME MEASURES Clinician administration adherence, surveys of perceptions, and organizational outcomes. RESULTS Initial adherence to the GAB was 46% and increased to >85% after 6 months. These adherence levels remained consistent 48 months after implementation. Clinician perceptions of measure use were initially high (>63%), with significant improvements in knowledge and use of one measure after implementation. CONCLUSIONS We successfully implemented the assessment battery with high levels of adherence to recommendations, likely as a consequence of using the bundle of knowledge translation activities, facilitation, and use of a framework to co-develop the plan. These changes in practice were sustainable, as determined by a 4-year follow-up.

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