Abstract
Background and Purpose: Physical therapists tend to underuse research evidence in clinical practice. Emerging research on knowledge translation activities (KTAs) provides guidance to address this problem. We describe a yearlong effort to promote clinical practice behavior change in neurologic physical therapists.
Case Description: Physical therapy stroke and brain injury teams in an inpatient rehabilitation setting implemented a quality improvement project to encourage use of a novel, evidence-supported gait training method (nonsupported gait training [NSGT]) for patients with hemiparesis.
Intervention: The project consisted of multidimensional KTAs, including (1) quarterly staff meetings at which NSGT was introduced, reviewed, and discussed; (2) group and individual dialogue regarding successes, challenges, solutions, and clinical decision-making; (3) ongoing monitoring of and aggregate feedback about appropriate NSGT attempts via chart audit; and (4) ongoing reminders, role modeling, and clinical consultation. Specific staff perceptions about the approach, captured by a mid-year survey, further informed targeted problem-solving and clinical case presentations.
Outcomes: In the first, second, and fourth quarter, 50%, 60%, and 73% of eligible patients were trained with NSGT, respectively. A mid-year survey showed that 19% of therapists were very/moderately familiar with NSGT before the quality improvement project, versus 78% at the 6-month point. Thirty-three percent stated that they used NSGT almost always/often before the project, versus 66% at the 6-month point.
Discussion: Extensive multidimensional KTAs were feasible in inpatient rehabilitation and were accompanied by a moderate increase in documented and self-reported frequency of NSGT attempts. Clinical teams may benefit from adopting KTAs that best support clinical practice change.
Video Abstract available (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A69) for more insights from the authors.