Perceived barriers and facilitators to high-intensity gait training in stroke rehabilitation: A Delphi study

ObjectiveTo identify common barriers and facilitators among physical therapists to implementing high-intensity gait training for patients post-stroke during inpatient rehabilitation.DesignA three-round Delphi study using free text responses and five-point Likert scales for agreement.Participants60 physical therapists with expertise treating patients with stroke in inpatient rehabilitation were invited. 33 participants completed all three rounds of surveys.Main MeasuresRound 1 consisted of two free text questions. Qualitative responses from round one were coded using the Theoretical Domains Framework and used to generate Likert scale survey items for rounds two and three. Consensus was defined a priori as ≥75% agreement. Response stability was evaluated with the Wilcoxon rank sum test.ResultsAnalysis identified 24 themes (12 facilitators, 12 barriers). Seven facilitators reached consensus: access to equipment (84.9%), built environment (78.8%), administrative support (78.8%), peer support (75.8%), team commitment to evidence-based practice (75.8%), high-intensity gait training-specific training (75.8%), and observable patient improvement (75.8%). Only one barrier reached consensus: treatment time interruptions (97.9%), including delays from toileting, hygiene, and medication administration. Other themes ranged from 18.2% to 57.6% agreement. No significant change in responses was found between rounds (p > 0.05).ConclusionsMore facilitators than barriers reached consensus, with treatment time interruptions as the primary agreed-upon barrier. Despite knowledge of high-intensity gait training and supportive factors, fewer than half of participants reported daily use. Targeted implementation strategies addressing time and workflow disruptions are needed to increase high-intensity gait training adoption in inpatient rehabilitation.