Moore Jennifer L, Krøll Pia, Berg Håvard Hansen, Sinnes Merethe B, Arntsen Roger, Henderson Chris E, Hornby T George, Rimehaug Stein Arne, Lilleheie Ingvild, Orpana Anders
Regional Rehabilitation Knowledge Center, Sunnaas Rehabilitation Hospital, 1453 Nesodden, Norway.
Institute for Knowledge Translation, Carmel, IN 46033, USA.
J Clin Med. 2025 Jul 31;14(15):5409. doi: 10.3390/jcm14155409.
: High-intensity gait training (HIT) is an evidence-based intervention recommended for stroke rehabilitation; however, its implementation in routine practice is inconsistent. This study examined the real-world implementation of HIT in an inpatient rehabilitation setting in Norway, focusing on fidelity, barriers, and knowledge translation (KT) strategies. : Using the Knowledge-to-Action (KTA) framework, HIT was implemented in three phases: pre-implementation, implementation, and competency. Fidelity metrics and coverage were assessed in 99 participants post-stroke. Barriers and facilitators were documented and categorized using the Consolidated Framework for Implementation Research. : HIT was delivered with improved fidelity during the implementation and competency phases, reflected by increased stepping and heart rate metrics. A coverage rate of 52% was achieved. Barriers evolved over time, beginning with logistical and knowledge challenges and shifting toward decision-making complexity. The KT interventions, developed collaboratively by clinicians and external facilitators, supported implementation. : Structured pre-implementation planning, clinician engagement, and external facilitation enabled high-fidelity HIT implementation in a real-world setting. Pragmatic, context-sensitive strategies were critical to overcoming evolving barriers. Future research should examine scalable, adaptive KT strategies that balance theoretical guidance with clinical feasibility to sustain evidence-based practice in rehabilitation.
高强度步态训练（HIT）是一种基于证据的推荐用于中风康复的干预措施；然而，其在常规实践中的实施情况并不一致。本研究考察了挪威住院康复环境中HIT的实际实施情况，重点关注保真度、障碍和知识转化（KT）策略。使用知识到行动（KTA）框架，HIT分三个阶段实施：实施前、实施和能力阶段。对99名中风后参与者的保真度指标和覆盖率进行了评估。使用实施研究综合框架记录并分类障碍和促进因素。在实施和能力阶段，HIT的实施保真度有所提高，表现为步幅和心率指标增加。实现了52%的覆盖率。障碍随时间演变，最初是后勤和知识方面的挑战，后来转向决策复杂性。由临床医生和外部促进者共同制定的KT干预措施支持了实施。结构化的实施前规划、临床医生参与和外部促进使得在现实环境中能够高保真地实施HIT。务实、因地制宜的策略对于克服不断演变的障碍至关重要。未来的研究应考察可扩展、适应性强的KT策略，这些策略要在理论指导与临床可行性之间取得平衡，以维持康复中的循证实践。
