Department of Physical Therapy, University of Toronto, Toronto, Canada.
Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
Disabil Rehabil. 2022 Jul;44(14):3719-3735. doi: 10.1080/09638288.2020.1867653. Epub 2021 Jan 16.
The iWalk study showed that 10-meter walk test (10mWT) and 6-minute walk test (6MWT) administration post-stroke increased among physical therapists (PTs) following introduction of a toolkit comprising an educational guide, mobile app, and video. We describe the use of theory guiding toolkit development and a process evaluation.
We used the knowledge-to-action framework to identify research steps; and a guideline implementability framework, self-efficacy theory, and the transtheoretical model to design and evaluate the toolkit and implementation process (three learning sessions). In a before-and-after study, 37 of the 49 participating PTs completed online questionnaires to evaluate engagement with learning sessions, and rate self-efficacy to perform recommended practices pre- and post-intervention. Thirty-three PTs and 7 professional leaders participated in post-intervention focus groups and interviews, respectively.
All sites conducted learning sessions; attendance was 50-78%. Self-efficacy ratings for recommended practices increased and were significant for the 10mWT ( ≤ 0.004). Qualitative findings highlighted that theory-based toolkit features and implementation strategies likely facilitated engagement with toolkit components, contributing to observed improvements in PTs' knowledge, attitudes, skill, self-efficacy, and clinical practice.
The approach may help to inform toolkit development to advance other rehabilitation practices of similar complexity.Implications for RehabilitationToolkits are an emerging knowledge translation intervention used to support widespread implementation of clinical practice guideline recommendations.Although experts recommend using theory to inform the development of knowledge translation interventions, there is little guidance on a suitable approach.This study describes an approach to using theories, models and frameworks to design a toolkit and implementation strategy, and a process evaluation of toolkit implementation.Theory-based features of the toolkit and implementation strategy may have facilitated toolkit implementation and practice change to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke.
iWalk 研究表明，在引入包括教育指南、移动应用程序和视频在内的工具包后，物理治疗师（PT）增加了 10 米步行测试（10mWT）和 6 分钟步行测试（6MWT）的应用。我们描述了使用理论指导工具包开发和过程评估。
我们使用知识转化行动框架来确定研究步骤；并使用指南实施可行性框架、自我效能理论和跨理论模型来设计和评估工具包和实施过程（三个学习课程）。在一项前后对照研究中，49 名参与的 PT 中有 37 名完成了在线问卷，以评估学习课程的参与度，并在干预前后评估实施推荐实践的自我效能感。33 名 PT 和 7 名专业领导者分别参加了干预后的焦点小组和访谈。
所有站点都进行了学习课程；出勤率为 50-78%。推荐实践的自我效能感评分增加，10mWT 显著（≤0.004）。定性研究结果强调，基于理论的工具包功能和实施策略可能有助于参与工具包组件，有助于观察到 PT 知识、态度、技能、自我效能感和临床实践的改善。
该方法可能有助于为其他类似复杂性的康复实践提供信息，以促进工具包的开发。
工具包是一种新兴的知识转化干预措施，用于支持临床实践指南建议的广泛实施。尽管专家建议使用理论来为知识转化干预措施的制定提供信息，但关于合适方法的指导很少。本研究描述了一种使用理论、模型和框架设计工具包和实施策略的方法，以及对工具包实施的过程评估。工具包和实施策略的基于理论的功能可能促进了工具包的实施和实践的改变，以增加成人中风后步行速度和距离的临床测量和解释。
