# Implementing High-Intensity Gait Training in Stroke Rehabilitation: A Real-World Pragmatic Approach

## TL;DR

This study explores how high-intensity gait training can be effectively implemented in stroke rehabilitation using practical strategies in a real-world setting.

## Contribution

The study introduces a pragmatic, real-world approach to implementing high-intensity gait training in stroke rehabilitation using the KTA framework.

## Key findings

- HIT was delivered with improved fidelity during the implementation and competency phases.
- A coverage rate of 52% was achieved, with barriers evolving from logistical to decision-making complexity.
- Collaborative knowledge translation strategies supported successful implementation.

## Abstract

Background: High-intensity gait training (HIT) is an evidence-based intervention recommended for stroke rehabilitation; however, its implementation in routine practice is inconsistent. This study examined the real-world implementation of HIT in an inpatient rehabilitation setting in Norway, focusing on fidelity, barriers, and knowledge translation (KT) strategies. Methods: Using the Knowledge-to-Action (KTA) framework, HIT was implemented in three phases: pre-implementation, implementation, and competency. Fidelity metrics and coverage were assessed in 99 participants post-stroke. Barriers and facilitators were documented and categorized using the Consolidated Framework for Implementation Research. Results: HIT was delivered with improved fidelity during the implementation and competency phases, reflected by increased stepping and heart rate metrics. A coverage rate of 52% was achieved. Barriers evolved over time, beginning with logistical and knowledge challenges and shifting toward decision-making complexity. The KT interventions, developed collaboratively by clinicians and external facilitators, supported implementation. Conclusions: Structured pre-implementation planning, clinician engagement, and external facilitation enabled high-fidelity HIT implementation in a real-world setting. Pragmatic, context-sensitive strategies were critical to overcoming evolving barriers. Future research should examine scalable, adaptive KT strategies that balance theoretical guidance with clinical feasibility to sustain evidence-based practice in rehabilitation.