Experiences of physical therapists and professional leaders with implementing a toolkit to advance walking assessment poststroke: A realist evaluation

Toolkits do little to help recovery. You need EXACT STROKE PROTOCOLS. GET THERE!

Experiences of physical therapists and professional leaders with implementing a toolkit to advance walking assessment poststroke: A realist evaluation

Physical Therapy , Volume 101(12)

NARIC Accession Number: J88997.  What's this?
ISSN: 0031-9023.
Author(s): Salbach, Nancy M.; McDonald, Alison; MacKay-Lyons, Marilyn; Bulmer, Beverly; Howe, Jo-Anne; Bayley, Mark T.; McEwen, Sara; Nelson, Michelle; Solomon, Patricia.
Publication Year: 2021.
Number of Pages: 11.

Abstract: 

Study examined the influence of contextual circumstances on use of a toolkit and implementation strategy across acute care and inpatient and outpatient rehabilitation settings. The iWalk toolkit and implementation strategy was designed to guide physical therapists in using the 10-Meter Walk Test (10MWT) and 6-Minute Walk Test (6MWT) for evaluation of walking, education, goal setting and treatment selection post stroke. The toolkit comprised a mobile app, video, and educational guide outlining instructions for 3 learning sessions. After completing learning sessions, 33 physical therapists and 7 professional leaders participated in focus groups or interviews. As part of a realist evaluation, the study compared and synthesized site-specific context-mechanism-outcome descriptions across sites to refine an initial theory of how the toolkit would influence practice. Analysis revealed 3 context-mechanism-outcomes: (1) No onsite facilitator? No practice change in acute care: Without an onsite facilitator, participants lacked authority to facilitate and coordinate the implementation strategy; (2) Onsite facilitation fostered integration of select practices in acute care: When onsite facilitation occurred in acute care, walk test administration and use of reference values for patient education were adopted variably with high functioning patients; (3) Onsite facilitation fostered integration of most practices in rehabilitation settings: When onsite facilitation occurred, many participants incorporated 1 or both tests to evaluate and monitor walking capacity, and reference values were applied for inpatient and outpatient education and goal setting. Participants preferentially implemented the 10MWT over the 6MWT because set-up and administration were easier, and a greater proportion of patients could walk 10 meters.
Descriptor Terms: ACUTE CARE, AMBULATION, CLINICAL MANAGEMENT, MEASUREMENTS, OUTCOMES, PHYSICAL THERAPY, REHABILITATION, SERVICE UTILIZATION, STROKE.


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Citation: Salbach, Nancy M., McDonald, Alison, MacKay-Lyons, Marilyn, Bulmer, Beverly, Howe, Jo-Anne, Bayley, Mark T., McEwen, Sara, Nelson, Michelle, Solomon, Patricia. (2021). Experiences of physical therapists and professional leaders with implementing a toolkit to advance walking assessment poststroke: A realist evaluation.  Physical Therapy , 101(12) Retrieved 6/23/2022, from REHABDATA database.