Development and Evaluation of iWalk: A Guide to Facilitate Evidence-informed Assessment of Walking After Stroke

Summary

Stroke remains a major health concern and the second highest cause of disability worldwide. After experiencing a stroke, many people lose the ability to walk independently. As a result, people with stroke require intensive rehabilitation services, spend the majority of their time in physical therapy on retraining walking, and cite recovery of walking as a primary rehabilitation goal. Assessment of walking using reliable and valid tools is a recommended practice in stroke rehabilitation guidelines in Canada, the United States, Australia, and The Netherlands. The 10-metre walk test (10mWT) and the 6-minute walk test (6MWT) are highly recommended in guidelines and by professional organizations for the clinical evaluation of walking across the care continuum. For the 10mWT, the time to traverse the middle 10 metres of a 14-metre walkway at a comfortable pace is used to compute comfortable walking speed. For the 6MWT, the maximum distance achieved walking back and forth along a 30-metre walkway in six minutes is documented.

To facilitate physical therapists' (PTs') use of an evidence-informed approach to administering these walking tests post-stroke in an acute care, inpatient rehabilitation, or outpatient rehabilitation setting, the iWalk Toolkit, a theory-based toolkit, was developed. This Toolkit consists of an educational guide, a smartphone app, and an educational video.

In this mixed methods study, PTs across multiple sites were evaluated before and after a 5-month intervention involving the implementation of the iWalk Toolkit. Objectives of this study were: (1) to determine the nature and extent to which PTs across the care continuum uptake/use information in a theory-based toolkit designed to guide use of the 10-metre and 6-minute walk tests post-stroke for initial assessment, goal setting, education, treatment selection and monitoring change; and (2) to describe PTs' perceptions of the features of the guide, the provider and the setting that facilitated or prevented walk test administration and use of test scores for initial assessment, prognosis, goal setting, treatment selection and monitoring change.

Conditions

• Stroke

Interventions

OTHER

iWalk Toolkit

Intervention period: 5 months Intervention: 1. A toolkit consisting of 3 components: an educational guide, a smartphone app, and an educational video. 2. Access to a clinical expert by email or phone

Sponsors & Collaborators

• Dalhousie University

  collaborator OTHER

• University Health Network, Toronto

  collaborator OTHER

• Nova Scotia Health Authority

  collaborator OTHER

• McMaster University

  collaborator OTHER

• CorHealth Ontario

  collaborator OTHER

• Drexel University

  collaborator OTHER

• Sunnybrook Health Sciences Centre

  collaborator OTHER

• Sinai Health System

  collaborator OTHER

• Unity Health Toronto

  collaborator OTHER

• University of Toronto

  lead OTHER

Principal Investigators

• Nancy Salbach, PhD · University of Toronto

Study Design

Allocation

NA

Purpose

DIAGNOSTIC

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2015-09-01

Primary Completion

2017-06-30

Completion

2017-06-30