Faculty of Health & Wellbeing, University of Central Lancashire, Preston, Lancashire, United Kingdom PR1 2HE.
Department of Physical Therapy, University of British Columbia, and Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, British Columbia, Canada.
Phys Ther. 2018 Apr 1;98(4):243-250. doi: 10.1093/ptj/pzy018.
The evidence base for stroke rehabilitation recommends intensive and repetitive task-specific practice, as well as aerobic exercise. However, translating these -evidence-based interventions from research into clinical practice remains a major -challenge.
The objective of this study was to investigate factors influencing implementation of higher-intensity activity in stroke rehabilitation settings.
This qualitative study used a cross-sectional design.
Semi-structured interviews were conducted with rehabilitation therapists from 4 sites across 2 Canadian provinces who had experience in delivering a higher-intensity intervention as part of a clinical trial (Determining Optimal post-Stroke Exercise [DOSE]). An interview guide was developed, and data were analyzed using implementation frameworks.
Fifteen therapists were interviewed before data saturation was reached. Therapists and patients generally had positive experiences regarding high-intensity interventions. However, therapists felt they would adapt the protocol to accommodate their beliefs about ensuring movement quality. The requirement for all patients to have a graded exercise test and the use of sensors (eg, heart rate monitors) gave therapists confidence to push patients harder than they normally would. Paradoxically, a system that enables routine graded exercise testing and the availability of staff and equipment contribute challenges for implementation in everyday practice.
Even therapists involved in delivering a high-intensity intervention as part of a trial wanted to adapt it for clinical practice; therefore, it is imperative that researchers are explicit regarding key intervention components and what can be adapted to help ensure implementation fidelity. Changes in therapists' beliefs and system-level changes (staffing and resources) are likely necessary to facilitate higher-intensity rehabilitation in practice.
中风康复的循证医学推荐强化、重复的任务特异性练习以及有氧运动。然而，将这些基于证据的干预措施从研究转化为临床实践仍然是一个主要的挑战。
本研究旨在调查影响中风康复环境中更高强度活动实施的因素。
这是一项使用横截面设计的定性研究。
对来自加拿大 2 个省的 4 个地点的有经验实施更高强度干预（作为临床试验的一部分，确定最佳中风后运动[DOSE]）的康复治疗师进行半结构式访谈。制定了访谈指南，并使用实施框架对数据进行分析。
在达到数据饱和之前，对 15 名治疗师进行了访谈。治疗师和患者对高强度干预通常有积极的体验。然而，治疗师认为他们会根据确保运动质量的信念来调整方案。所有患者都需要进行分级运动测试和使用传感器（如心率监测器）的要求，使治疗师有信心更努力地推动患者。矛盾的是，一个能够进行常规分级运动测试以及拥有员工和设备的系统，给日常实践中的实施带来了挑战。
即使是参与作为试验一部分提供高强度干预的治疗师也希望对其进行调整以适应临床实践；因此，研究人员明确关键干预措施以及可以进行调整以帮助确保实施保真度的内容至关重要。治疗师的信念和系统级别的变化（人员配备和资源）可能需要进行改变，以促进实践中的更高强度康复。
