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

Jennifer L. Moore*, Roberta Virva, Chris Henderson, Lauren Lenca, John F. Butzer, Linda Lovell, Elliot Roth, Ian D. Graham, T. George Hornby

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: 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 effect of the study intervention on clinician adherence to the recommendations and its effect on clinician perceptions and the organization. Design: Pre- and post-training intervention study. Setting: Subacute inpatient rehabilitation facility. Participants: Physical therapists (N=6) and physical therapist assistants (N=2). Intervention: The intervention comprised a bundle of activities, including codeveloping and executing the plan with clinicians and leaders. The multicomponent 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 more than 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 because of using the bundle of knowledge translation activities, facilitation, and use of a framework to codevelop the plan. These changes in practice were sustainable, as determined by a 4-year follow-up.

Original languageEnglish (US)
JournalArchives of physical medicine and rehabilitation
DOIs
StateAccepted/In press - 2021

Keywords

  • Gait
  • Gait disorders, neurologic
  • Implementation science
  • Neurological rehabilitation
  • Outcome assessment, health care
  • Physical and rehabilitation medicine
  • Physical therapy specialty
  • Rehabilitation
  • Translational medical research
  • Walking speed

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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