Abstract Body: Objective: Despite guidelines recommending intensive rehabilitation for walking recovery after stroke, its implementation remains challenging. Our understanding of barriers and facilitators in real-world settings remains minimal. We aimed to understand the implementation factors for intensive rehabilitation within real-world inpatient rehabilitation settings.
Methods: A cross-sectional online survey design was used. We invited 85 therapy staff (physiotherapists + therapy assistants) who delivered the structured, progressive intensive rehabilitation protocol (>2000 steps, 40-60% heart rate reserve, >30 minutes/session) as usual care from 12 sites (7 Canadian provinces) within the Walk ’n Watch implementation trial (NCT04238260). Fitbit step counters and Garmin heart rate monitors were provided. The survey was developed by a multidisciplinary team (clinicians, scientists, and a stroke patient), including close-ended (Likert agreement scale) and open-ended questions regarding protocol practicalities, workplace structure, and support. Close-ended responses were descriptively summarized. Open-ended responses were thematically analyzed using the Consolidated Framework for Implementation Research (CFIR).
Results: Forty-seven therapy staff (85% female; mean 13 ± 10 years clinical experience) completed the survey. Most therapy staff agreed that they delivered the protocol safely and successfully (87%) and that the step and heart rate targets were helpful (72%). However, only about one-third agreed that they had enough time to deliver the protocol (36%); 26% and 47% agreed that they achieved the prescribed step count and heart rate targets, respectively. The major time-related factor was insufficient therapy time to accommodate the 30-minute protocol, besides other required therapy activities (CFIR Work Infrastructure). For example, discharge planning often took priority near the end of the stay. Most agreed to future use of the protocol (87%). However, only about half agreed to future use of the trial-assigned devices (49% step counters, 64% heart rate monitors), likely due to perceptions of device inaccuracies (CFIR Materials & Equipment).
Conclusions: Therapy staff reported successfully delivering an intensive rehabilitation protocol as usual care under real-world conditions. Strategies identified to facilitate implementation included building in discharge planning considerations within the protocol and acquiring more accurate step counters and heart rate monitors.