Diermayr G1, Schomberg M1, Greisberger A2, Gronwald M3, Elsner B3, Salbach NM4
1SRH University of Applied Sciences Heidelberg, Heidelberg, Germany, 2FH Campus Wien, Vienna, Austria, 3SRH University of Applied Health Sciences Gera, Gera, Germany, 4University of Toronto, Toronto, Canada
Background: People with stroke cite mobility deficits as one of the most burdensome limitations. Within the statutory German/Austrian health care systems, physical therapy (PT) post-stroke is based on traditional neurodevelopmental therapy (NDT) and the amount of PT prescribed may not meet recommendations for high repetitions of task oriented training required for motor learning. Moreover, a shortage of PT personnel has been reported, especially in Germany. Task-oriented circuit training (TCT) incorporates high repetitive training in a group setting and seems personnel-efficient. A systematic Cochrane review by English et al. (2017) showed clinically important improvements in mobility outcomes (i.e. walking distance and speed) especially for the chronic stage post-stroke. The quality of evidence using GRADE was reported to be moderate for these two outcomes. However, the contextual challenges to implementing TCT into routine community-based care in Germany/Austria are unknown.
Purpose: The purpose of this study was to determine the implementation potential of TCT into community-based PT services post-stroke in Germany/Austria.
Methods: This study is based on a guideline developed by Cochrane Germany and an expert group of allied health scholars. It guides the process of identifying, evaluating and implementing evidence-based health care innovations into routine care.
Using predefined questions from the Cochrane guideline we identified differences between study characteristics outlined in the Cochrane review on TCT and routine care in Germany/Austria, which could influence the feasibility of implementing and therefore the effects of the intervention in the target context. Specifically, factors within settings, clients, intervention provider, intervention content and intervention outcome measures were explored. Reports from German/Austrian health insurances, professional organizations, national stroke guidelines and the statutory health insurance regulations for PT treatment ('Heilmittelkatalog') provided the source for evaluating possible differences.
Results: The following factors may influence the implementation and/or effect of the intervention:
Setting:
a) Spacious rooms for group therapy are typically not available in community-based practices in Germany/Austria.
b) The number of clients with similar functional ability per practice might be too low for typical group therapy.
c) The cost coverage by statutory health care systems may be unprofitable for physical therapists or involve extra costs for clients.
Client: Clinical characteristics are comparable across contexts (i.e. clients in chronic stroke stage); however, motivation for group therapy is unknown.
Intervention provider and content: Physical therapists are trained in stroke rehabilitation and group therapy. However, neurological PT in Germany/Austria is traditionally provided in a 1:1 client-to-therapist ratio with hands-on treatment as a crucial element (i.e. NDT prescription). Hence, TCT represents a change in practice (and prescription) patterns.
Outcome measures: Primary outcome measures used in TCT studies are available in German.
Conclusion(s): While TCT is scientifically well established, barriers to implementation into routine care in Germany/Austria can be expected at the health care system-, client- and therapist-levels.
Implications: To validate our results and to overcome the barriers for implementation relevant stakeholders will be involved in a next step using knowledge translation methodology. For example, using the Theoretical Domains Framework, therapists' knowledge, motivation or self-efficacy in regards to TCT should be evaluated to inform development of a behavior change process.
Keywords: circuit training, knowledge translation, mobility
Funding acknowledgements: SRH Förderstiftung
Purpose: The purpose of this study was to determine the implementation potential of TCT into community-based PT services post-stroke in Germany/Austria.
Methods: This study is based on a guideline developed by Cochrane Germany and an expert group of allied health scholars. It guides the process of identifying, evaluating and implementing evidence-based health care innovations into routine care.
Using predefined questions from the Cochrane guideline we identified differences between study characteristics outlined in the Cochrane review on TCT and routine care in Germany/Austria, which could influence the feasibility of implementing and therefore the effects of the intervention in the target context. Specifically, factors within settings, clients, intervention provider, intervention content and intervention outcome measures were explored. Reports from German/Austrian health insurances, professional organizations, national stroke guidelines and the statutory health insurance regulations for PT treatment ('Heilmittelkatalog') provided the source for evaluating possible differences.
Results: The following factors may influence the implementation and/or effect of the intervention:
Setting:
a) Spacious rooms for group therapy are typically not available in community-based practices in Germany/Austria.
b) The number of clients with similar functional ability per practice might be too low for typical group therapy.
c) The cost coverage by statutory health care systems may be unprofitable for physical therapists or involve extra costs for clients.
Client: Clinical characteristics are comparable across contexts (i.e. clients in chronic stroke stage); however, motivation for group therapy is unknown.
Intervention provider and content: Physical therapists are trained in stroke rehabilitation and group therapy. However, neurological PT in Germany/Austria is traditionally provided in a 1:1 client-to-therapist ratio with hands-on treatment as a crucial element (i.e. NDT prescription). Hence, TCT represents a change in practice (and prescription) patterns.
Outcome measures: Primary outcome measures used in TCT studies are available in German.
Conclusion(s): While TCT is scientifically well established, barriers to implementation into routine care in Germany/Austria can be expected at the health care system-, client- and therapist-levels.
Implications: To validate our results and to overcome the barriers for implementation relevant stakeholders will be involved in a next step using knowledge translation methodology. For example, using the Theoretical Domains Framework, therapists' knowledge, motivation or self-efficacy in regards to TCT should be evaluated to inform development of a behavior change process.
Keywords: circuit training, knowledge translation, mobility
Funding acknowledgements: SRH Förderstiftung
Topic: Neurology: stroke; Research methodology & knowledge translation; Professional practice: other
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: N/A
All authors, affiliations and abstracts have been published as submitted.
