Applying the Knowledge-to-Action Framework to Implement Gait and Balance Assessments in Inpatient Stroke Rehabilitation

 This to me indicates that the top down approach is completely wrong, you give the survivors the protocols that are out there with efficacy ratings and the survivors give them to the therapists and doctors to implement.  Survivors would ensure that they get the protocols they need and if they don't exist the doctors and therapists are in charge of getting them created.  The current situation of non-existent stroke protocols is the result of nobody taking charge. Survivors would take charge since their recovery hangs in the balance. 

Survivors don't give a fuck about assessments, they want the real thing; PROTOCOLS THAT DELIVER RECOVERY.

Applying the Knowledge-to-Action Framework to Implement Gait and Balance Assessments in Inpatient Stroke Rehabilitation

• Jennifer L. Moore, PT, DHS
• Roberta Virva, PT
• Chris Henderson, PT, PhD
• 
  
• Elliot Roth, MD
• Ian D. Graham, PhD, FCAHS
• T. George Hornby, PT, PhD
• Show all authors

Published:November 26, 2020DOI:https://doi.org/10.1016/j.apmr.2020.10.133

This paper is only available as a PDF. To read, Please Download here.

Abstract

Objective

The overall objectives of this project were to implement and sustain use of a gait assessment battery (GAB) that included the Berg Balance Scale, 10 Meter Walk Test, and 6 Minute Walk Test during inpatient stroke rehabilitation. The study objective was to assess the impact of the study intervention on clinician adherence to the recommendations and its impact on clinician perceptions and the organization.

Design

Pre and post-training intervention study.

Setting

Subacute inpatient rehabilitation facility.

Participants

Six Physical therapists and two physical therapist assistants.

Intervention.

The intervention comprised a bundle of activities including co-developing and executing the plan with clinicians and leaders. The multi-component implementation plan was based on the Knowledge-to-Action Framework, and included implementation facilitation, implementation leadership, and a bundle of knowledge translation interventions that targeted barriers. Implementation was an iterative process in which results from one implementation phase informed planning of the next phase.

Main Outcome Measures.

Clinician administration adherence, surveys of perceptions, and organizational outcomes.

Results

Initial adherence to the GAB was 46% and increased to >85% after 6 months. These adherence levels remained consistent 48 months after implementation. Clinician perceptions of measure use were initially high (>63%), with significant improvements in knowledge and use of one measure after implementation.

Conclusions

We successfully implemented the assessment battery with high levels of adherence to recommendations, likely as a consequence of using the bundle of knowledge translation activities, facilitation, and use of a framework to co-develop the plan. These changes in practice were sustainable, as determined by a 4-year follow-up.