Tapp Annie, Dray Daniel, Griswold David, Haybarger Richard, Learman Kenneth
Department of Graduate Studies in Health and Rehabilitation, Youngstown State University, Youngstown, OH, USA.
Department of Rehabilitation, Mercy Health St. Elizabeth's Hospital, Youngstown, OH, USA.
Physiother Theory Pract. 2025 Jul;41(7):1378-1387. doi: 10.1080/09593985.2024.2424354. Epub 2024 Nov 5.
The Academy of Neurologic Physical Therapy's Intensity Matters campaign recommends the implementation of high-intensity locomotor training for all patients with neurologic dysfunction with goals to improve walking.
Retrospectively determine the effectiveness of a clinician-initiated implementation project on the adoption, reach, and fidelity of high-intensity locomotor training for patients with stroke during inpatient rehabilitation and, determine whether the project led to changes in patient outcomes.
Retrospective analysis of electronic medical records from 1 year before and after the project. Patients admitted with a stroke diagnosis were included. Demographic information, the number of high-intensity sessions, the percentage of time spent in the target heart rate zone, standardized assessment scores for motor function, functional mobility, balance, gait speed and endurance, and discharge destination were extracted for descriptive and linear mixed model analysis.
Clinician reach was 75%, and adoption of high-intensity training varied between clinicians from 47.1% and 83.3%. Of eligible patients, 55% received the target intervention at least once, reflecting the patient reach. Implementation fidelity was 18.84%. Linear mixed effects modeling revealed a statistically significant effect of time ( < .001) but not group allocation or group × time interaction.
Although statistically significant differences in patient outcomes compared to pre-implementation were not found, results highlight the limitations associated with adopting high-intensity locomotor training for patients post-stroke in this setting .It remains unclear whether the implementation fidelity achieved was sufficient to impact patient outcomes. Further research is needed to establish fidelity targets and identify barriers to successful implementation projects by clinicians.
神经物理治疗学会的“强度至关重要”运动建议对所有神经功能障碍患者实施高强度运动训练，目标是改善步行能力。
回顾性确定临床医生发起的实施项目对住院康复期间中风患者采用高强度运动训练、覆盖范围和依从性的有效性，并确定该项目是否导致患者结局发生变化。
对项目前后1年的电子病历进行回顾性分析。纳入中风诊断入院的患者。提取人口统计学信息、高强度训练课程数量、在目标心率区间花费的时间百分比、运动功能、功能活动能力、平衡、步态速度和耐力的标准化评估分数以及出院去向，进行描述性和线性混合模型分析。
临床医生的覆盖范围为75%，临床医生对高强度训练的采用率在47.1%至83.3%之间。在符合条件的患者中，55%至少接受过一次目标干预，这反映了患者覆盖范围。实施依从性为18.84%。线性混合效应模型显示时间有统计学显著效应（<0.001），但分组分配或组×时间交互作用无显著效应。
虽然未发现与实施前相比患者结局有统计学显著差异，但结果突出了在这种情况下对中风后患者采用高强度运动训练的相关局限性。尚不清楚所实现的实施依从性是否足以影响患者结局。需要进一步研究来确定依从性目标，并识别临床医生成功实施项目的障碍。
