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

Area of Science:

• Neurorehabilitation
• Implementation Science
• Clinical Practice Improvement

Background:

• Stroke rehabilitation requires standardized gait assessments for optimal patient outcomes.
• Clinician adherence to evidence-based assessment protocols can be challenging.
• The Knowledge-to-Action Framework offers a structured approach to implementing clinical interventions.

Purpose of the Study:

• To implement and sustain the use of a gait assessment battery (GAB) during inpatient stroke rehabilitation.
• To evaluate the impact of a multicomponent intervention on clinician adherence to the GAB.
• To assess changes in clinician perceptions and organizational outcomes related to GAB implementation.

Main Methods:

• A pre- and post-training intervention study was conducted in a subacute inpatient rehabilitation facility.
• The intervention involved co-developing an implementation plan with clinicians and leaders, utilizing facilitation and knowledge translation strategies.
• Clinician adherence, perceptions, and organizational outcomes were measured using surveys and administrative data.

Main Results:

• Clinician adherence to the GAB increased from 46% to over 85% within 6 months and remained consistent at 48 months post-implementation.
• Clinician perceptions of measure use were initially high and showed significant improvements in knowledge and utilization.
• The study demonstrated sustained high adherence levels over a 4-year follow-up period.

Conclusions:

• A multicomponent implementation strategy, including facilitation and a co-developed plan, successfully improved and sustained clinician adherence to a gait assessment battery.
• The findings highlight the effectiveness of the Knowledge-to-Action Framework in driving sustainable practice change in rehabilitation settings.
• The study provides evidence for the long-term impact of implementing standardized gait assessments on clinical practice and potentially patient outcomes.