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Implementing High-Intensity Gait Training in Stroke Rehabilitation: A Real-World Pragmatic Approach.

Jennifer L Moore1,2, Pia Krøll3, Håvard Hansen Berg3

  • 1Regional Rehabilitation Knowledge Center, Sunnaas Rehabilitation Hospital, 1453 Nesodden, Norway.

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|August 14, 2025
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Summary

High-intensity gait training (HIT) implementation in stroke rehabilitation improved with structured planning and clinician engagement. Knowledge translation strategies helped overcome evolving barriers to evidence-based practice.

Keywords:
biomedicalgait disordersimplementation scienceknowledge translationneurologicphysical therapy specialtystroke rehabilitationtranslation science

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Area of Science:

  • Rehabilitation Medicine
  • Implementation Science

Background:

  • High-intensity gait training (HIT) is recommended for stroke rehabilitation but faces inconsistent real-world application.
  • Understanding implementation barriers and knowledge translation (KT) is crucial for effective practice.

Purpose of the Study:

  • To examine the real-world implementation of HIT in Norwegian inpatient rehabilitation.
  • To assess fidelity, identify barriers, and evaluate KT strategies used in HIT delivery.

Main Methods:

  • The Knowledge-to-Action (KTA) framework guided a three-phase implementation (pre-implementation, implementation, competency).
  • Fidelity, coverage (n=99 post-stroke), barriers, and facilitators were assessed using established frameworks.

Main Results:

  • HIT fidelity improved, indicated by increased stepping and heart rate metrics.
  • A 52% coverage rate was achieved, with barriers evolving from logistical to decision-making complexity.
  • Collaboratively developed KT interventions facilitated implementation.

Conclusions:

  • Structured pre-implementation, clinician involvement, and external facilitation enabled high-fidelity HIT.
  • Context-sensitive strategies are vital for overcoming implementation barriers.
  • Future research should focus on scalable, adaptive KT strategies for sustained evidence-based practice.