Patients' experiences while undergoing high-intensity gait training during inpatient stroke rehabilitation: a...

High-intensity gait training is an evidence-based intervention for improving walking outcomes after stroke, but little is known about how patients experience this intervention during inpatient rehabilitation. Understanding patient perspectives may help inform implementation strategies that support engagement, acceptability, and continuity of care. This study explored the experiences of patients undergoing high-intensity gait training during inpatient stroke rehabilitation in Norway.

A qualitative descriptive study was conducted across three inpatient rehabilitation centers in Norway where high-intensity gait training was delivered as part of routine physiotherapy. Eleven adults receiving inpatient rehabilitation after stroke participated in semi-structured interviews after discharge. Interviews were audio-recorded, transcribed, anonymized, and analyzed using reflexive thematic analysis. Three researchers independently coded the transcripts and developed preliminary categories through discussion. Themes were refined by the analysis team, with review from a fourth researcher.

Two main themes were identified: the "active ingredients of rehabilitation" and the "organization of the health system." Patients described the patient-clinician relationship, unit culture, and their own health-related experiences as important influences on engagement in high-intensity gait training. Trust, encouragement, confidence-building, and perceived safety supported participation in challenging activities. Patients also described how transitions between care settings, interruptions in rehabilitation, staffing limitations, and differences in care quality shaped their rehabilitation experience and influenced their ability to continue progressing.

Patients' engagement in high-intensity gait training was shaped by relational, individual, and system-level factors beyond the physical demands of the intervention itself. Clinician behaviors that foster trust, motivation, confidence, and psychological safety may be important components of successful implementation. At the system level, coordinated transitions and continuity of rehabilitation services may support patient participation and sustained access to high-intensity rehabilitation across the stroke care pathway. Patients' experiences while undergoing high-intensity gait training: insights from qualitative patient interviews.