Monday, December 23, 2024

From Evidence to Practice: Efficacy and Implementation of High-intensity Locomotor Training for Stroke Rehabilitation

 And your doctorate advisors didn't inform you of problems with HIT?  You will 100% guarantee that HIT will not cause a stroke? By verifying that your aneurysms will not blow out?

Do you really want to do high intensity training?

Because Andrew Marr blames high-intensity training for his stroke. 

Can too much exercise cause a stroke?

From Evidence to Practice: Efficacy and Implementation of High-intensity Locomotor Training for Stroke Rehabilitation

Abstract Details

2024, Doctor of Philosophy in Health Sciences, Youngstown State University, Department of Graduate Studies in Health and Rehabilitation Sciences.
This dissertation investigates the efficacy and real-world implementation of high-intensity locomotor training (HIT) for stroke patients during inpatient rehabilitation. The project was guided by three specific aims: (1) to evaluate the strength of the evidence supporting HIT for improving ambulation outcomes, (2) to determine whether clinicians can replicate these results in a real-world setting, and (3) to identify the barriers and facilitators to implementing HIT in inpatient rehabilitation facilities (IRFs) across the United States. The first study, a systematic review, confirmed that HIT is more effective than usual care in improving gait speed and endurance at discharge for patients with stroke, with moderate effect sizes on meta-analysis. The second study, a retrospective analysis of a clinician-initiated HIT project, revealed challenges in replicating these outcomes in a real world setting, possibly due to low implementation fidelity suggesting that a minimum threshold of fidelity may be necessary to see unit-wide improvements. The third study used a Delphi survey approach to explore the experiences of clinicians implementing HIT in IRFs. While several facilitators to HIT adoption were identified, a notable barrier was insufficient time, consistent with barriers to evidence-based practice reported in other rehabilitation disciplines. Despite favorable conditions, less than half of surveyed clinicians reported using HIT daily, indicating ongoing challenges. HIT is an effective intervention for improving walking ability in patients post-stroke during inpatient rehabilitation. Future research should focus on addressing key barriers, exploring optimal dosing strategies and fidelity targets, and developing interdisciplinary approaches to increase the widespread adoption of HIT across the continuum of care in stroke rehabilitation.
David Griswold, PhD (Committee Chair)
Kenneth Learman, PhD (Committee Member)
Susan Linder, DPT (Committee Member)
Nancy Landgraff, PhD (Committee Member)
123 p.

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