PDF(Pubmed)
Abstract：
(1) Background: High-intensity gait training (HIT) is a recommended intervention that improves walking function (e.g., speed and distance) in individuals who are undergoing stroke rehabilitation. This study explored clinicians\' perceived barriers and facilitators to implementing HIT utilizing a mixed-methods approach comprising a survey and exploratory qualitative research. (2) Methods: Clinicians (n = 13) who were implementing HIT at three facilities participated. We collected and analyzed data using the consolidated framework for implementation research. Three focus groups were recorded and transcribed, and data were coded and thematically categorized. (3) Results: Survey results identified that the facilitators with a strong impact on implementation were access to knowledge/resources and intervention knowledge/beliefs. The only agreed-upon barrier with a strong impact was lack of tension for change. The focus groups resulted in 87 quotes that were coded into 27 constructs. Frequently cited outer setting facilitators were cosmopolitanism and peer pressure, and the only barrier was related to the patient needs. Innovation characteristics that were facilitators included relative advantage and design quality and packaging, and complexity was a barrier. Inner setting facilitators included networks and communication, learning climate, leadership engagement, and readiness for implementation. However, communication, leadership engagement, and available resources were also barriers. Regarding characteristics of individuals, knowledge and beliefs were both barriers and facilitators. In the implementation process domain, common facilitators were formally appointed implementation leaders and innovation participants. Barriers in this domain were related to the patients. (4) Conclusions: Clinicians identified many barriers and facilitators to implementing HIT that often varied between facilities. Further research is warranted to deepen our understanding of clinicians\' experiences with HIT implementation.
摘要：
（1）背景：高强度步态训练（HIT）是一种推荐的干预措施，可改善步行功能（例如，速度和距离)在接受中风康复的个体中。这项研究探索了临床医生的感知障碍和促进者，以利用包括调查和探索性定性研究在内的混合方法实施HIT。（2）方法：在三个设施中实施HIT的临床医生（n=13）参加。我们使用合并的实施研究框架收集和分析数据。三个焦点组被记录和转录，和数据被编码和主题分类。（3）结果：调查结果确定，对实施产生重大影响的促进者是获得知识/资源和干预知识/信念。唯一具有强大影响的商定障碍是缺乏变革的张力。焦点小组产生了87个报价，这些报价被编码为27个构造。经常被引用的外部环境促进者是世界主义和同伴压力，唯一的障碍与患者的需求有关。推动者的创新特征包括相对优势、设计质量和包装，复杂性是一个障碍。内部设置促进者包括网络和通信，学习氛围，领导参与,并做好实施准备。然而,通信,领导参与,可用资源也是障碍。关于个人的特征，知识和信念既是障碍又是促进者。在实现过程域中，共同促进者被正式任命为实施领导者和创新参与者。该领域的障碍与患者有关。（4）结论：临床医生确定了实施HIT的许多障碍和促进者，这些障碍和促进者通常在设施之间有所不同。有必要进行进一步的研究，以加深我们对临床医生HIT实施经验的理解。
