The Interface of Clinical Decision-Making With Study Protocols for Knowledge Translation From a Walking Recovery Trial.
Julie A Hershberg, Dorian K Rose, Julie K Tilson and 8 others
PMID 27977522WHAT IT FOUND
Therapists adapted LEAPS walking protocols in post-stroke trial cases when shoulder pain or poor leg control threatened progression, using movement analysis, adjusted support, and pain-free exercise.
Key findings
01In the home exercise case, the therapist stopped resistive upper-extremity exercises during shoulder pain and continued pain-free active range of motion with verbal and tactile cues.
02In the locomotor-training case, the therapist started at 40% body-weight support and later reduced support to 15% over 35 sessions.
03The reported cases include walking speed changes from 0.48 to 0.78 m/s and from 0.07 to 0.19 m/s, with daily steps changing from 547 to 1606.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only two cases are described, and they were selected by consensus, not by an empirical sampling plan. These cases do not show whether the protocols work; they are descriptive examples of decision-making. The therapists had a team-based approach and weekly multi-site support that may not be available in ordinary practice. A knowledge translation framework was not used during the LEAPS trial implementation.
Declared interests
The authors reported no conflict of interest or previous presentation.
The easy way to misread this
Do not read these cases as evidence that the LEAPS protocols caused the reported walking gains. The article selected representative participants and describes decision-making, not a controlled comparison.