Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.).
J Neurol Phys Ther. 2022 Oct 1;46(4):251-259. doi: 10.1097/NPT.0000000000000406. Epub 2022 Jun 7.
While underutilized, poststroke administration of the 10-m walk test (10mWT) and 6-minute walk test (6MWT) can improve care and is considered best practice. We aimed to evaluate provision of a toolkit designed to increase use of these tests by physical therapists (PTs).
In a before-and-after study, 54 PTs and professional leaders in 9 hospitals were provided a toolkit and access to a clinical expert over a 5-month period. The toolkit comprised a guide, smartphone app, and video, and described how to set up walkways, implement learning sessions, administer walk tests, and interpret and apply test results clinically. The proportion of hospital visits for which each walk test score was documented at least once (based on abstracted health records of ambulatory patients) were compared over 8-month periods pre- and post-intervention using generalized mixed models.
Data from 347 and 375 pre- and postintervention hospital visits, respectively, were analyzed. Compared with preintervention, the odds of implementing the 10mWT were 12 times greater (odds ratio [OR] = 12.4, 95% confidence interval [CI] 5.8, 26.3), and of implementing the 6MWT were approximately 4 times greater (OR = 3.9, 95% CI 2.3, 6.7), post-intervention, after adjusting for hospital setting, ambulation ability, presence of aphasia and cognitive impairment, and provider-level clustering. Unadjusted change in the percentage of visits for which the 10mWT/6MWT was documented at least once was smallest in acute care settings (2.0/3.8%), and largest in inpatient and outpatient rehabilitation settings (28.0/19.9% and 29.4/23.4%, respectively).
Providing a comprehensive toolkit to hospitals with professional leaders likely contributed to increasing 10mWT and 6MWT administration during inpatient and outpatient stroke rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A390 ).
尽管（脑卒中患者的）10 米步行测试（10mWT）和 6 分钟步行测试（6MWT）的应用尚未普及，但进行这些测试可改善治疗效果，被认为是最佳实践。我们旨在评估一套工具包的应用效果，该工具包旨在提高物理治疗师（PTs）对这些测试的应用。
在一项前后对照研究中，9 家医院的 54 名 PT 和专业领导者在 5 个月的时间内获得了工具包和临床专家的支持。该工具包包括指南、智能手机应用程序和视频，介绍了如何设置步行道、实施学习课程、进行步行测试以及在临床实践中解释和应用测试结果。使用广义混合模型，在干预前后 8 个月的时间段内，根据门诊患者的健康记录摘要，比较每个步行测试评分至少记录一次的医院就诊比例。
分别分析了 347 次和 375 次干预前后医院就诊的数据。与干预前相比，实施 10mWT 的可能性增加了 12 倍（优势比[OR] = 12.4，95%置信区间[CI] 5.8，26.3），实施 6MWT 的可能性增加了约 4 倍（OR = 3.9，95% CI 2.3，6.7），这是在调整医院环境、步行能力、是否存在失语症和认知障碍以及提供者水平聚类后得出的结果。未调整的 10mWT/6MWT 至少记录一次的就诊百分比变化最小的是急性护理环境（2.0/3.8%），最大的是住院和门诊康复环境（分别为 28.0/19.9%和 29.4/23.4%）。
为有专业领导者的医院提供全面的工具包可能有助于增加住院和门诊脑卒中康复期间的 10mWT 和 6MWT 应用。
视频摘要可从作者处获得更多见解（请观看视频，补充数字内容 1，可在以下网址获取：http://links.lww.com/JNPT/A390）。
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