Department of Physical Therapy Faculty Articles
The Interface of Clinical Decision-Making With Study Protocols for Knowledge Translation From a Walking Recovery Trial
Publication Title
Journal of Neurologic Physical Therapy
Publisher
Academy of Neurologic Physical Therapy
ISSN
1557-0576
Publication Date
1-2017
Keywords
Locomotor Training, Stroke, Knowledge Translation, Clinical Decision-Making
Abstract
Background and Purpose: Despite efforts to translate knowledge into clinical practice, barriers often arise in adapting the strict protocols of a randomized, controlled trial (RCT) to the individual patient. The Locomotor Experience Applied Post-Stroke (LEAPS) RCT demonstrated equal effectiveness of 2 intervention protocols for walking recovery poststroke; both protocols were more effective than usual care physical therapy. The purpose of this article was to provide knowledge-translation tools to facilitate implementation of the LEAPS RCT protocols into clinical practice.
Methods: Participants from 2 of the trial's intervention arms: (1) early Locomotor Training Program (LTP) and (2) Home Exercise Program (HEP) were chosen for case presentation. The two cases illustrate how the protocols are used in synergy with individual patient presentations and clinical expertise. Decision algorithms and guidelines for progression represent the interface between implementation of an RCT standardized intervention protocol and clinical decision-making.
Outcomes: In each case, the participant presents with a distinct clinical challenge that the therapist addresses by integrating the participant's unique presentation with the therapist's expertise while maintaining fidelity to the LEAPS protocol. Both participants progressed through an increasingly challenging intervention despite their own unique presentation.
Summary: Decision algorithms and exercise progression for the LTP and HEP protocols facilitate translation of the RCT protocol to the real world of clinical practice. The two case examples to facilitate translation of the LEAPS RCT into clinical practice by enhancing understanding of the protocols, their progression, and their application to individual participants.
DOI
10.1097/NPT.0000000000000158
Volume
41
Issue
1
First Page
59
Last Page
67
Disciplines
Medicine and Health Sciences
NSUWorks Citation
Hershberg, Julie A. PT, DPT, NCS; Rose, Dorian K. PT, PhD; Tilson, Julie K. PT, DPT, MS; Brutsch, Bettina PT; Correa, Anita PT; Gallichio, Joann PT, DSc, NCS; McLeod, Molly PT, NCS; Moore, Craig PT; Wu, Sam PhD; Duncan, Pamela W. PT, PhD; and Behrman, Andrea L. PT, PhD, "The Interface of Clinical Decision-Making With Study Protocols for Knowledge Translation From a Walking Recovery Trial" (2017). Department of Physical Therapy Faculty Articles. 8.
https://nsuworks.nova.edu/hpd_pt_facarticles/8
