Real-World Experiences of Therapy Staff Implementing an Intensive Rehabilitation Protocol in Canadian Stroke Inpatient Rehabilitation Settings : A Multi-Site Survey Study

Hung, Stanley H. and Ackerley, Suzanne and Connell, Louise and Bayley, Mark and Best, Krista and Donkers, Sarah J. and Dukelow, Sean and Ezeugwu, Victor and Milot, Marie-Helene and Peters, Sue and Sakakibara, Brodie and Sheehy, Lisa and Yao, Jennifer and Eng, Janice (2025) Real-World Experiences of Therapy Staff Implementing an Intensive Rehabilitation Protocol in Canadian Stroke Inpatient Rehabilitation Settings : A Multi-Site Survey Study. Physical Therapy, 105 (10): pzaf111. ISSN 0031-9023

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Abstract

Importance: While best practice guidelines recommend intensive rehabilitation for post-stroke walking recovery, knowledge of real-world implementation factors is limited. Objective: The aim was to understand the implementation factors for intensive rehabilitation within real-world inpatient stroke rehabilitation settings. Design: This was a cross-sectional, online survey study. Setting: Twelve inpatient rehabilitation units (7 Canadian provinces) were included. Participants: Eighty-five therapy staff who delivered an intensive rehabilitation protocol within the Walk ‘n Watch implementation trial (NCT04238260) were invited. Intervention: A structured intensive walking rehabilitation protocol was implemented as usual care (>2000 steps, 40%-60% heart rate reserve, >30 minutes/session). Step counters and heart rate monitors were provided. Main Outcomes and Measures: An online survey was used, including close-ended and open-ended questions regarding the protocol practicalities, workplace structure, and training. Open-ended responses were thematically analyzed using the Consolidated Framework for Implementation Research (CFIR). Results: Forty-seven participants (85% women) completed the survey. Most agreed they successfully delivered the protocol (87%) and found the step and heart rate targets helpful (72%). However, few participants agreed they had enough time to deliver the protocol (36%); 26% and 47% agreed they achieved the step count and heart rate targets, respectively. The major time-related factor was insufficient therapy time to accommodate the protocol and prescribed step targets (CFIR: Work Infrastructure); discharge planning often took priority. Most agreed to future protocol use (87%). However, only about half agreed to future use of the trial-assigned devices (49% step counters; 64% heart rate monitors), likely due to perceived device inaccuracies (CFIR: Materials and Equipment). Conclusions: Therapy staff reported successfully delivering an intensive rehabilitation protocol as usual care under real-world conditions. Strategies to facilitate implementation included incorporating discharge planning considerations, system-level changes, and acquiring more accurate monitoring devices. Relevance: This study enhanced the understanding of real-world implementation factors and potential strategies for future implementation.