Movement Matters, and So Does Context: Lessons Learned From Multisite Implementation of the Movement Matters Activity...

Area of Science:

• Rehabilitation Medicine
• Implementation Science
• Public Health

Background:

• Stroke recovery is often suboptimal due to fragmented care.
• Evidence-based rehabilitation guidelines are not consistently applied in post-acute settings.
• The "stroke belt" region faces unique challenges in stroke care delivery.

Purpose of the Study:

• To describe the rationale and design of the Movement Matters Activity Program for Stroke (MMAP).
• To evaluate the implementation successes and challenges of MMAP in North Carolina.
• To inform future complex intervention designs for stroke transitional care.

Main Methods:

• MMAP was implemented as part of a randomized multicenter pragmatic trial.
• Implementation strategies aligned with the Expert Recommendations for Implementing Change (ERIC) project.
• Feedback from site champions and facilitators was analyzed using the Consolidated Framework for Implementation Research (CFIR).

Main Results:

• MMAP implementation was challenging, requiring modifications due to provider and system factors.
• Program and study participation were limited by practice priorities and patient volume.
• Successful implementation was associated with empowered champions and integrated healthcare systems.

Conclusions:

• Implementing complex interventions like MMAP requires addressing system-level barriers.
• Strong leadership and organizational support are crucial for successful adoption of evidence-based practices.
• Findings offer a roadmap for designing and implementing future stroke care interventions.