Experiences of Physical Therapists and Professional Leaders With Implementing a Toolkit to Advance Walking Assessment Poststroke: A Realist Evaluation.
Nancy M Salbach, Alison McDonald, Marilyn MacKay-Lyons and 6 others
PMID 34636908WHAT IT FOUND
Therapists said implementation hinged on an onsite facilitator and a permanent walkway near treatment areas.
Without these, acute-care staff saw no way to use the tests. In rehab settings, most adopted the 10-Meter Walk Test but skipped the 6-Minute version because finding 30 meters of safe space was too hard.
Key findings
01An onsite facilitator was essential for organizing sessions and obtaining approval for permanent walkways; without one, acute-care therapists did not implement the recommended practices.
02The 10-Meter Walk Test was used far more than the 6-Minute Walk Test because it required less space, time, and equipment, and more patients could complete it.
03Therapists in acute care often skipped testing because patients could not walk, length of stay was short, and they believed documenting baseline values was irrelevant before transfer to rehab.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study did not include perspectives from patients or managers. It did not evaluate whether the practice changes lasted after the study ended. Settings without professional leaders were not studied, so the results may not apply to hospitals without such roles. Quantitative and qualitative data were not triangulated to check if reported barriers matched actual usage rates. Participants were from two urban centers in Canada, which may limit transferability to other health systems.
Declared interests
Funders (Government of Ontario, Canadian Institutes of Health Research, Heart and Stroke Foundation) played no role in the design, conduct, or reporting of this study.
The easy way to misread this
Do not read the therapists' positive attitudes toward the toolkit or their reported use of the app as evidence that the intervention improved patient outcomes. This study reports on the process of implementation and the barriers to changing assessment habits, not on whether the walk tests led to better walking recovery.