The role of theory to develop and evaluate a toolkit to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke

The iWalk study showed that 10-meter walk test (10mWT) and 6-minute walk test (6MWT) administration post-stroke increased among physical therapists (PTs) following introduction of a toolkit comprising an educational guide, mobile app, and video. We describe the use of theory guiding toolkit development and a process evaluation. We used the knowledge-to-action framework to identify research steps; and a guideline implementability framework, self-efficacy theory, and the transtheoretical model to design and evaluate the toolkit and implementation process (three learning sessions). In a before-and-after study, 37 of the 49 participating PTs completed online questionnaires to evaluate engagement with learning sessions, and rate self-efficacy to perform recommended practices pre- and post-intervention. Thirty-three PTs and 7 professional leaders participated in post-intervention focus groups and interviews, respectively. All sites conducted learning sessions; attendance was 50-78%. Self-efficacy ratings for recommended practices increased and were significant for the 10mWT (<i>p</i> ≤ 0.004). Qualitative findings highlighted that theory-based toolkit features and implementation strategies likely facilitated engagement with toolkit components, contributing to observed improvements in PTs’ knowledge, attitudes, skill, self-efficacy, and clinical practice. The approach may help to inform toolkit development to advance other rehabilitation practices of similar complexity.Implications for RehabilitationToolkits are an emerging knowledge translation intervention used to support widespread implementation of clinical practice guideline recommendations.Although experts recommend using theory to inform the development of knowledge translation interventions, there is little guidance on a suitable approach.This study describes an approach to using theories, models and frameworks to design a toolkit and implementation strategy, and a process evaluation of toolkit implementation.Theory-based features of the toolkit and implementation strategy may have facilitated toolkit implementation and practice change to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke. Toolkits are an emerging knowledge translation intervention used to support widespread implementation of clinical practice guideline recommendations. Although experts recommend using theory to inform the development of knowledge translation interventions, there is little guidance on a suitable approach. This study describes an approach to using theories, models and frameworks to design a toolkit and implementation strategy, and a process evaluation of toolkit implementation. Theory-based features of the toolkit and implementation strategy may have facilitated toolkit implementation and practice change to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke.

iWalk研究显示，卒中后患者的10米步行测试（10mWT）与6分钟步行测试（6MWT）的实施工作，在物理治疗师（PTs）引入包含教育指南、移动应用程序与视频的配套工具包后有所提升。
本研究阐述了指导配套工具包开发的理论应用方法，以及一项过程评估工作。
本研究采用知识转化框架（knowledge-to-action framework）确定研究步骤；同时运用指南可实施性框架（guideline implementability framework）、自我效能感理论（self-efficacy theory）与跨理论模型（transtheoretical model），对配套工具包及实施流程（含三次学习课程）进行设计与评估。
在一项前后对照研究（before-and-after study）中，49名参与的物理治疗师中有37名完成了在线问卷，用于评估其对学习课程的参与程度，并对干预前后执行推荐临床实践的自我效能感进行评分。
另有33名物理治疗师与7名行业负责人分别参与了干预后的焦点小组讨论与访谈。
所有试点机构均开展了学习课程，参与率达50%至78%。
推荐临床实践的自我效能评分有所提升，其中10米步行测试的评分提升具有统计学显著性（p ≤ 0.004）。
质性研究结果显示，基于理论构建的配套工具包功能与实施策略，或可提升物理治疗师对工具包各模块的参与度，进而推动其在知识、态度、技能、自我效能感与临床实践方面的改善。
该研究方法可为开发配套工具包提供参考，以推动其他复杂度相似的康复临床实践落地。

**康复领域启示**
配套工具包是一类新兴的知识转化干预（knowledge translation intervention）手段，用于支持临床实践指南推荐意见的广泛落地实施。
尽管专家建议以理论为指导开展知识转化干预工具的开发，但目前仍缺乏适配的实施路径指导。
本研究阐述了一套运用理论、模型与框架设计配套工具包及实施策略的方法，并对工具包的实施过程开展了过程评估。
基于理论构建的工具包功能与实施策略，或可推动工具包的落地实施与临床实践变革，进而提升卒中后成人步行速度与步行距离的临床测量与解读能力。

配套工具包是一类新兴的知识转化干预手段，用于支持临床实践指南推荐意见的广泛落地实施。
尽管专家建议以理论为指导开展知识转化干预工具的开发，但目前仍缺乏适配的实施路径指导。
本研究阐述了一套运用理论、模型与框架设计配套工具包及实施策略的方法，并对工具包的实施过程开展了过程评估。
基于理论构建的工具包功能与实施策略，或可推动工具包的落地实施与临床实践变革，进而提升卒中后成人步行速度与步行距离的临床测量与解读能力。