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The Interface of Clinical Decision-Making With Study Protocols for Knowledge Translation From a Walking Recovery
Julie A Hershberg1, Dorian K Rose, Julie K Tilson
1Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (J.H., J.T.); Malcom Randall VA Medical Center, University of Florida, Gainesville (D.R.); Rehabilitation Department, Florida Hospital Orlando (B.B., C.M.); MetroHealth Station, Los Angeles, California (A.C.); Nova Southeastern University, Tampa, Florida (J.G.); Camp Pendleton Hospital, Camp Pendleton, California (M.M.); Department of Biostatistics, University of Florida, Gainesville (S.W.); Department of Neurology, Wake Forest University Health Sciences, Winston-Salem, North Carolina (P.D.), and Department of Neurological Surgery-Pediatric Rehabilitation and Recovery Laboratory, University of Louisville, Louisville, Kentucky (A.B.).
Background And Purpose:
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 2 intervention protocols for walking recovery poststroke; both protocols were more effective than usual care physical therapy. The purpose of this article was to provide knowledge-translation tools to facilitate implementation of the LEAPS RCT protocols into clinical practice.
Methods:
Participants from 2 of the trial's intervention arms: (1) early Locomotor Training Program (LTP) and (2) Home Exercise Program (HEP) were chosen for case presentation. The two cases illustrate how the protocols are used in synergy with individual patient presentations and clinical expertise. Decision algorithms and guidelines for progression represent the interface between implementation of an RCT standardized intervention protocol and clinical decision-making.
Outcomes:
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.
Summary:
Decision algorithms and exercise progression for the LTP and HEP protocols facilitate translation of the RCT protocol to the real world of clinical practice. The two case examples to facilitate translation of the LEAPS RCT into clinical practice by enhancing understanding of the protocols, their progression, and their application to individual participants.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A147).
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