Hinrichs-Kinney Lauren A, Beisheim-Ryan Emma H, Butera Katie A, Braaten Melissa, Holtrop Jodi Summers, Stevens-Lapsley Jennifer E
VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA.
Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
PM R. 2025 May 19. doi: 10.1002/pmrj.13389.
Effective implementation of rehabilitation research into clinical practice is imperative to optimize patient outcomes; however, limitations persist. A systematic approach to develop implementation strategies can address known limitations.
To detail the systematic process for developing a strategy to implement high-intensity resistance rehabilitation (HIR) in skilled nursing facilities (SNFs), to be evaluated in future pragmatic trials.
Expert-informed, theory-driven development study.
Academic research institute.
An expert panel of clinician-researchers (n = 5) and SNF clinicians (n = 4) with experience implementing HIR collaborated on strategy development.
Development followed steps of implementation mapping: (1) identifying barriers and facilitators, (2) defining performance objectives, (3) selecting theory and evidence to develop the strategy, (4) producing the implementation strategy, and (5) planning for evaluation. Panel consensus meetings were held throughout the process.
MAIN OUTCOME MEASURE(S): Not applicable.
Barriers and facilitators were identified at patient, clinician, and facility levels. Performance objectives included: (1) screening all patients for suitability, (2) dosing rehabilitation interventions at a high intensity for appropriate patients, (3) monitoring and adjusting dosage per patient response, and (4) progressing patients each session. Adult learning theories, social cognitive theory, and a review of the literature on effective implementation strategies guided development of a multicomponent implementation strategy: (1) train and educate clinicians (e.g., online modules); (2) provide interactive assistance (e.g., external implementation facilitator, check-ins); (3) support clinicians (e.g., job aids); and (4) change infrastructure (e.g., equipment provision). An evaluation plan was constructed.
This work illustrates a systematic approach, guided by implementation, adult learning, and behavior change principles, for developing an implementation strategy to promote HIR implementation in diverse SNFs. Health care leaders, clinicians, and researchers can replicate this approach to enhance rehabilitation practices, improving patient care and outcomes. Future work will evaluate this strategy for HIR implementation in SNFs.
将康复研究有效应用于临床实践对于优化患者治疗效果至关重要；然而，相关限制依然存在。采用系统方法来制定实施策略可解决已知的限制因素。
详细阐述在专业护理机构（SNFs）中制定高强度抗阻康复（HIR）实施策略的系统过程，以便在未来的实用试验中进行评估。
专家指导、理论驱动的发展研究。
学术研究机构。
由具有实施HIR经验的临床研究人员（n = 5）和SNF临床医生（n = 4）组成的专家小组共同参与策略制定。
按照实施映射的步骤进行制定：（1）识别障碍和促进因素；（2）确定绩效目标；（3）选择理论和证据以制定策略；（4）制定实施策略；（5）规划评估。在整个过程中召开了专家小组共识会议。
不适用。
在患者、临床医生和机构层面识别出了障碍和促进因素。绩效目标包括：（1）对所有患者进行适用性筛查；（2）对合适的患者进行高强度康复干预；（3）根据患者反应监测并调整剂量；（4）每次治疗时使患者取得进展。成人学习理论、社会认知理论以及对有效实施策略的文献综述指导了多组分实施策略的制定：（1）培训和教育临床医生（如在线模块）；（2）提供互动协助（如外部实施促进者、定期检查）；（3）支持临床医生（如工作辅助工具）；（4）改变基础设施（如提供设备）。构建了评估计划。
这项工作展示了一种以实施、成人学习和行为改变原则为指导的系统方法，用于制定在不同SNFs中促进HIR实施的策略。医疗保健领导者、临床医生和研究人员可以复制这种方法来加强康复实践，改善患者护理和治疗效果。未来的工作将评估该策略在SNFs中实施HIR的效果。
