Facilitators and Barriers to Implementing High-Intensity Gait Training in Inpatient Stroke Rehabilitation: A...

Area of Science:

• Rehabilitation Medicine
• Implementation Science
• Clinical Practice Improvement

Background:

• High-intensity gait training (HIT) is a recommended intervention for improving walking function post-stroke.
• Successful implementation of HIT in clinical settings faces challenges.
• This study investigates clinician-perceived barriers and facilitators to HIT implementation.

Purpose of the Study:

• To explore clinicians' perceived barriers and facilitators to implementing high-intensity gait training (HIT).
• To identify factors influencing the adoption of HIT in stroke rehabilitation.
• To inform strategies for optimizing HIT implementation.

Main Methods:

• A mixed-methods approach was employed, combining surveys and exploratory qualitative research.
• Thirteen clinicians implementing HIT across three facilities participated.
• Data were analyzed using the Consolidated Framework for Implementation Research (CFIR) and thematic analysis.

Main Results:

• Facilitators included access to knowledge/resources, intervention knowledge, cosmopolitanism, peer pressure, relative advantage, design quality, networks, communication, learning climate, leadership engagement, readiness for implementation, and formally appointed leaders.
• Barriers included lack of felt need for change, patient needs, complexity, communication, leadership engagement, available resources, and patient-related issues.
• Individual characteristics like knowledge and beliefs acted as both barriers and facilitators.

Conclusions:

• Clinicians perceive a wide range of barriers and facilitators impacting HIT implementation.
• Implementation factors often varied significantly between different clinical facilities.
• Further research is needed to comprehensively understand clinician experiences with HIT implementation.