Real-World Experiences of Therapy Staff Implementing an Intensive Rehabilitation Protocol in Canadian Stroke Inpatient Rehabilitation Settings: A Multi-Site Survey Study.

IMPORTANCE: While best practice guidelines recommend intensive rehabilitation for post-stroke walking recovery, knowledge of real-world implementation factors is limited. OBJECTIVE: The aim was to understand the implementation factors for intensive rehabilitation within real-world inpatient stroke rehabilitation settings. DESIGN: This was a cross-sectional, online survey study. SETTING: Twelve inpatient rehabilitation units (7 Canadian provinces) were included. PARTICIPANTS: Eighty-five therapy staff who delivered an intensive rehabilitation protocol within the Walk 'n Watch implementation trial (NCT04238260) were invited. INTERVENTION: A structured intensive walking rehabilitation protocol was implemented as usual care (>2000 steps, 40%-60% heart rate reserve, >30 minutes/session). Step counters and heart rate monitors were provided. MAIN OUTCOMES AND MEASURES: An online survey was used, including close-ended and open-ended questions regarding the protocol practicalities, workplace structure, and training. Open-ended responses were thematically analyzed using the Consolidated Framework for Implementation Research (CFIR). RESULTS: Forty-seven participants (85% women) completed the survey. Most agreed they successfully delivered the protocol (87%) and found the step and heart rate targets helpful (72%). However, few participants agreed they had enough time to deliver the protocol (36%); 26% and 47% agreed they achieved the step count and heart rate targets, respectively. The major time-related factor was insufficient therapy time to accommodate the protocol and prescribed step targets (CFIR: Work Infrastructure); discharge planning often took priority. Most agreed to future protocol use (87%). However, only about half agreed to future use of the trial-assigned devices (49% step counters; 64% heart rate monitors), likely due to perceived device inaccuracies (CFIR: Materials and Equipment). CONCLUSIONS: Therapy staff reported successfully delivering an intensive rehabilitation protocol as usual care under real-world conditions. Strategies to facilitate implementation included incorporating discharge planning considerations, system-level changes, and acquiring more accurate monitoring devices. RELEVANCE: This study enhanced the understanding of real-world implementation factors and potential strategies for future implementation.