Application of evidence-based practice strategies: current trends in walking recovery interventions poststroke.

Abstract

Persons with impaired walking ability poststroke rely on rehabilitation specialists to provide the best available interventions that will maximize walking recovery and, ultimately, improve their community mobility and quality of life. Evidence-based practice (EBP) is a process in which the rehabilitation clinician integrates the "best" research evidence, clinical expertise, and patient circumstances, values, and preferences to provide the most appropriate interventions to address patient expectations and goals. Studies show that clinicians value EBP but are challenged by limited time, skills, and resources to successfully implement it in real-world practice. This article describes a five-step EBP framework and directs clinicians to free online resources designed to improve their ability to become evidence-based practitioners. The framework and tools are illustrated by answering three searchable clinical questions about interventions for walking recovery poststroke. Recommendations for walking recovery interventions poststroke are provided for aerobic conditioning, treadmill training with body weight support, and use of ankle-foot orthoses with and without functional electrical stimulation. To provide added insight related to individual patient application and intervention effectiveness, studies included are appraised to investigate the influence of patient chronicity (i.e., time poststroke), walking impairment severity, and intervention dose on walking outcomes and community mobility.