biostudies-literatureUnknown105(10)Hung SHHeart and Stroke Foundation Canadian Partnership for Stroke Recovery Operating GrantMichael Smith Health Research BC FellowshipCanada Research Chair ProgramCanada Brain Research FundCIHR<h4>Importance</h4>While best practice guidelines recommend intensive rehabilitation for post-stroke walking recovery, knowledge of real-world implementation factors is limited.<h4>Objective</h4>The aim was to understand the implementation factors for intensive rehabilitation within real-world inpatient stroke rehabilitation settings.<h4>Design</h4>This was a cross-sectional, online survey study.<h4>Setting</h4>Twelve inpatient rehabilitation units (7 Canadian provinces) were included.<h4>Participants</h4>Eighty-five therapy staff who delivered an intensive rehabilitation protocol within the Walk 'n Watch implementation trial (NCT04238260) were invited.<h4>Intervention</h4>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.<h4>Main outcomes and measures</h4>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).<h4>Results</h4>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).<h4>Conclusions</h4>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.<h4>Relevance</h4>This study enhanced the understanding of real-world implementation factors and potential strategies for future implementation.Physical therapypzaf111https://www.ebi.ac.uk/biostudies/studies/S-EPMC12554159biostudies-literatureReal-World Experiences of Therapy Staff Implementing an Intensive Rehabilitation Protocol in Canadian Stroke Inpatient Rehabilitation Settings: A Multi-Site Survey Study.PMC12554159Yao JBest KLMilot MHAckerley SDonkers SJHung SHConnell LADukelow SPPeters SSheehy LEzeugwu VEEng JJBayley MTSakakibara BMfalseReal-World Experiences of Therapy Staff Implementing an Intensive Rehabilitation Protocol in Canadian Stroke Inpatient Rehabilitation Settings: A Multi-Site Survey Study.<h4>Importance</h4>While best practice guidelines recommend intensive rehabilitation for post-stroke walking recovery, knowledge of real-world implementation factors is limited.<h4>Objective</h4>The aim was to understand the implementation factors for intensive rehabilitation within real-world inpatient stroke rehabilitation settings.<h4>Design</h4>This was a cross-sectional, online survey study.<h4>Setting</h4>Twelve inpatient rehabilitation units (7 Canadian provinces) were included.<h4>Participants</h4>Eighty-five therapy staff who delivered an intensive rehabilitation protocol within the Walk 'n Watch implementation trial (NCT04238260) were invited.<h4>Intervention</h4>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.<h4>Main outcomes and measures</h4>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).<h4>Results</h4>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).<h4>Conclusions</h4>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.<h4>Relevance</h4>This study enhanced the understanding of real-world implementation factors and potential strategies for future implementation.2025-01-01T00:00:00Z2025 Oct2026-06-05T06:40:55.152Z2026-06-05T03:06:38.416ZS-EPMC125541594113930910.1093/ptj/pzaf111