Implementation of High-Intensity Gait Training in the Acute Care Setting for Patients With Stroke

Introduction: The purpose of the present study was to describe the implementation of high-intensity gait training (HIGT) in the acute care setting and its potential impact on functional status and discharge disposition. Review of Literature: Early intensive rehabilitation after stroke, including HIGT, is critical for the recovery of walking function. However, no prior research has investigated the implementation of HIGT in the acute care setting. Subjects: A total of 159 patients with acute stroke and those who received HIGT were included in this study. Methods: A retrospective medical record review collected data on potential adverse events and information about HIGT intensity, duration, and timing of initiation. The potential effect of HIGT timing and dosing on the change in Activity Measure for Post-Acute Care basic mobility short form (AM-PAC 6-Clicks) and discharge disposition was examined using multivariate regression. Results: Most patients required an assist of 1 person (79.9%). Of the 335 HIGT sessions examined, there were only 23 adverse events (6.86%). Of those, 12 (3.6%) occurred during or immediately after a HIGT session. No adverse event resulted in a change of clinical status. No falls occurred during HIGT. When controlling for length of stay, HIGT dose was a statistically significant, independent predictor of change in AM-PAC 6-Clicks (adjusted R 2 = 0.22, β = 0.43, P < .001). HIGT dose was not a statistically significant predictor of change in discharge disposition. Discussion and Conclusion: HIGT appears to be feasible and safe for patients post stroke in the acute care setting. Although a greater dose of HIGT may be associated with greater improvement in functional status, these results need to be replicated and the long-term impact needs to be investigated.