Rehabilitation Tools, Guidelines and Applications

iWalk: Development of a toolkit using a guideline implementability framework to facilitate an evidence-informed approach to using the 10-metre and 6-minute walk tests post-stroke

  • The 10-metre walk test (10mWT) and 6-minute walk test (6MWT) are recommended post-stroke
  • Walk test protocols vary and there is little guidance on how to integrate an evidence informed approach to using these tests in clinical practice
  • We developed and validated a guide, a video, and a smartphone application to facilitate physical therapists’ application of an evidence informed approach to using the 10mWT and 6MWT post-stroke
  • In a before-and-after study conducted at 9 hospital sites in Ontario and Nova Scotia, the odds of implementing each test significantly increased following introduction of the toolkit, after adjusting for provider level clustering, hospital setting, ambulation ability, and presence of aphasia and impaired cognition

Knowledge Translation

iWalk Toolkit:
The iWalk Toolkit consists of the iWalk Guide, iWalk Videos, and the iWalkAssess app.

iWalk Guide:
To download the iWalk Guide, click here. Online resources referred to in the iWalk Guide are provided below.

iWalk Online Resources:
1-Equipment & Space Requirements Checklist
2-Learning Sessions-Instructions & Agendas
3-Equipment & Training Costs to Implement the 10mWT & 6MWT
4-10-metre Walk Test (Comfortable Pace) Protocol
5-10mWT (Comfortable Pace) Instructions for People with Aphasia
6-10mWT (Comfortable Pace) Data Collection & Goal Setting Form
7-6-Minute Walk Test Protocol
8-6-Minute Walk Test Instructions for People with Aphasia
9-Rating of Perceived Exertion Scale
10-6MWT Data Collection & Goal Setting Form
11-Walking Speed Age- and Sex-Specific Normative Values
12-Using Walking Speed to Classify Individuals as Household vs Community Ambulators
13-Distances Required to Walk at Community Locations
14-Quick Look-Up Sheet-Reference Values for 10mWT & 6MWT

iWalk Videos:

iWalk educational video on how to administer the 10-metre walk test and the 6-minute walk test in people post-stroke
iWalk video showing a person with stroke performing the 10-metre walk test
iWalk video showing a person with stroke performing the 6-minute walk test

iWalkAssess App:

Click the App Store logo to download the iOS version and click the Google Play logo to download the Android version.

Webinar: Knowledge to action: How the iWalk Toolkit can improve walking assessment post-stroke. Presenter: Nancy Salbach.

The practice and predictors of early mobilization of patients post-acute admission to a specialized stroke center

  • Mobilizing patients early post-stroke is recommended in the Canadian Stroke Best Practice Recommendations
  • We reviewed 296 health records at a specialized acute care hospital
  • Out-of-bed mobilization occurred in 24% of patients by 12 hours post-admission and in 77% of patients by 48 hours post-admission

Knowledge Translation

Ho E*, Cheung SH*, Denton M*, Kim BD*, Stephenson F*, Ching J, Boyle K, Lyeo S, Salbach NM. The practice and predictors of early mobilization of patients post-acute admission to a specialized stroke center. Topics in Stroke Rehabilitation, 2018. DOI: https://doi.org/10.1080/10749357.2018.1507308

*MScPT students

Clinical and psychosocial predictors of exceeding target length of stay during inpatient stroke rehabilitation

  • Clinical practice guidelines recommend a target length of stay at inpatient rehabilitation hospitals based on age and functional level for people post-stroke in Ontario, Canada
  • We reviewed 165 health records at an inpatient rehabilitation hospital
  • 38% of patients exceeded their target length of stay

Knowledge Translation

Lai W*, Buttineau M*, Harvey JK*, Pucci RA*, Wong APM*, Dell’Erario L, Bosnyak S, Reid S, Salbach NM. Clinical and psychosocial predictors of exceeding target length of stay during inpatient stroke rehabilitation. Topics in Stroke Rehabilitation. 2017. DOI: http://dx.doi.org/10.1080/10749357.2017.1325589

*MScPT students

A case-based implementation tool for increasing awareness of a new clinical practice guide to HIV rehabilitation

  • Realize developed a comprehensive electronic module (e-module) describing an interprofessional, evidence-informed approach to HIV rehabilitation and made it freely available online (realizecanada.org)
  • We interviewed 26 rehabilitation professionals in Canada and the United Kingdom after they participated in a 10-week case-based knowledge translation intervention to increase awareness of the e-module
  • Increased or reinforced knowledge and confidence in the management of people living with HIV were described

Knowledge Translation

Salbach NM, Solomon P, O’Brien KK, Worthington C, Baxter L, Blanchard G, Casey A, Chegwidden W, Dolan L, Eby S, Gervais N. Design features of a guideline implementation tool designed to increase awareness of a clinical practice guide to HIV rehabilitation: A qualitative process evaluation. Journal of Evaluation in Clinical Practice. DOI: https://doi.org/10.1111/jep.13070.

Solomon P, Salbach NM, O’Brien K, Worthington C, Baxter L, Blanchard G, Casey A, Chegwidden W, Dolan L, Eby S, Gervais N. Increasing capacity in rehabilitation in the management of HIV: A case-based e-mail intervention. Journal of Continuing Education and Professional Development 2015;2:1-8. DOI: doi:10.7726/jcepd.2015.1001

Case Study 1 – Sonia (part A)
Case Study 2 – Sonia (part B)
Case Study 3 – Louis
Case Study 4 – John
Case Study 5 – Geoff
Case Study 6 – Stella

Factors influencing physical therapists’ use of standardized measures of walking capacity post-stroke across the care continuum: A qualitative study

Person walking with a cane

  • An in-depth understanding of physical therapists’ approaches to walking assessment is needed to develop strategies to advance assessment practice
  • We interviewed 28 physical therapists working in acute care, rehabilitation and outpatient settings
  • A hierarchy of factors, including characteristics of the assessment tool, the therapist, the workplace, and patients, as well as influential individuals or organizations, affected assessment practice
  • Familiarity exerted the primary influence on adoption of a tool, whereas patient factors commonly determined daily use

Knowledge Translation

Pattison KM*, Brooks D, Cameron JI, Salbach NM. Factors influencing physical therapists’ use of standardized measures of walking capacity poststroke across the care continuum. Physical Therapy 2015;95:1507-17. DOI: 10.2522/ptj.20140267

*MSc student

Quality and clinical utility of functional walk tests among people with stroke: A systematic review

A close up of the hash marks in a crosswalk

  • Research literature supporting the clinical use of time- and distance-limited tests of walking distance and speed post-stroke is extensive and difficult to access
  • We conducted systematic reviews to appraise and synthesize research evidence on the reliability, validity, administration and interpretability of self-paced functional walk tests among people with stroke

Knowledge Translation

Salbach NM, O’Brien K, Brooks D, Irvin E, Martino R, Takhar P, Chan S, Howe J. Considerations for the selection of time-limited walk tests post-stroke: A systematic review of test protocols and measurement properties. Journal of Neurologic Physical Therapy. 2017;41:3-17. DOI: 10.1097/NPT.0000000000000159

Salbach NM, O’Brien K, Brooks D, Irvin E, Martino R, Takhar P, Chan S, Howe J. Reference values for standardized tests of walking speed and distance: A systematic review. Gait & Posture 2015; 41 (2): 341-360. DOI: http://dx.doi.org/10.1016/j.gaitpost.2014.10.002

Salbach NM, O’Brien K, Brooks D, Irvin E, Martino R, Takhar P, Chan S, Howe J. Speed and distance requirements for community ambulation: A systematic review. Archives of Physical Medicine and Rehabilitation 2014;95:117-28. DOI: http://dx.doi.org/10.1016/j.apmr.2013.06.017

Cardiorespiratory responses during the six-minute walk test and ramp cycle ergometry test and their relationship to physical activity in stroke

A person with a cane walking along a sidewalk under tree canopy

  • Walk tests are more feasible than progressive exercise tests to complete in the clinical setting; however, their utility for evaluating cardiorespiratory fitness post-stroke is unclear
  • 16 people post-stroke completed the 6-minute walk test and a ramp cycle ergometer test and wore an accelerometer for 5 days
  • Findings indicate that walk test performance may reflect cardiorespiratory fitness; however, neither walk nor cycle test performance was associated with time spent upright per day

Knowledge Translation

Salbach NM, Brooks D, Romano J, Woon L. The relationship between clinical measures and daily physical activity and participation in ambulatory, community-dwelling people with stroke. Journal of Novel Physiotherapies 2013, 3-6. http://dx.doi.org/10.4172/2165-7025.1000182

Salbach NM, Brooks D, Romano J, Woon L, Dolmage TE. Cardiorespiratory responses during the six-minute walk test and ramp cycle ergometry test and their relationship to physical activity in stroke. Neurorehabilitation and Neural Repair 2014;28(2):111-119. DOI: 10.1177/1545968313498826

Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT)

Score Recommendations Cover

  • SCORE-IT was a two-group cluster randomized controlled trial conducted in 20 inpatient rehabilitation hospitals across Canada
  • The objective was to evaluate whether a facilitated approach to implementing a stroke rehabilitation guideline was more likely than a passive approach to improve patient mobility and upper extremity function
  • A planned process evaluation was designed to assess whether the type and number of recommended treatments implemented by stroke teams helped to explain the results related to patient outcomes
  • Registration: http://www.clinicaltrials.gov. Unique identifier-NCT00359593

Knowledge Translation

Salbach NM, Wood-Dauphinee S, Desrosiers J, Eng JJ, Graham ID, Jaglal SB, Korner-Bitensky N, MacKay-Lyons M, Mayo NE, Richards CL, Teasell RW, Zwarenstein M, Bayley MT. Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial. Implementation Science 12:100, 2017. DOI 10.1186/s13012-017-0631-7.

Munce S, Graham ID, Salbach NM, Jaglal SB, Richards CL, Eng JJ, Desrosiers J, MacKay-Lyons M, Wood-Dauphinee S, Korner-Bitensky N, Mayo NE, Teasell RW, Zwarenstein M, Mokry J, Black S, Bayley MT. Perspectives of health care professionals on the facilitators and barriers to the implementation of a stroke rehabilitation guidelines cluster randomized controlled trial. BMC Health Services Research. 2017. Doi: 10.1186/s12913-017-2389-7.

Validation of the Evidence-based Practice Confidence (EPIC) Scale

“If I have the belief that I can do it,
I shall surely acquire the capacity to do it
even if I may not have it at the beginning.”

~ Mahatma Gandhi ~

You may freely download the Word version of the EPIC Scale. Please acknowledge the scale developers by citing the articles listed as appropriate.

Salbach NM, Jaglal SB. Creation and validation of the evidence-based practice confidence scale for health care professionals. Journal of Evaluation in Clinical Practice 2011;17(4):794-800. DOI: http://dx.doi.org/10.1111/j.1365-2753.2010.01478.x

Salbach NM, Jaglal SB, Williams JI. Reliability and validity of the evidence-based practice confidence (EPIC) scale. Journal of Continuing Education in the Health Professions 2013; 33(1): 33-40. DOI: 10.1002/chp.21164

Salbach NM, Williams JI, Jaglal SB. Reply to Bland: Despite error in formula, EPIC scale still precise. Journal of Continuing Education in the Health Professions 33(4):283, 2013. DOI: 10.1002/chp.21195

Clyde JH, Brooks D, Cameron JI, Salbach NM. Validation of the evidence-based practice confidence (EPIC) scale among occupational therapists. American Journal of Occupational Therapy 2016. 70, 7002280010. DOI: http://dx.doi.org/10.5014/ajot.2016.017061

Exploring physical therapists’ experiences integrating research evidence into clinical practice post-stroke: A qualitative study

Salbach NM, Veinot P, Rappolt S, Bayley M, Burnett D, Judd M, Jaglal SB. Physical therapists’ experiences updating the clinical management of walking rehabilitation after stroke: a qualitative study. Physical Therapy 2009;89:556-568. DOI: http://dx.doi.org/10.2522/ptj.20080249

Salbach NM, Veinot P, Jaglal SB, Bayley M, Rolfe D. From continuing education to personal digital assistants: What do physical therapists need to support evidence-based practice in stroke management? Journal of Evaluation in Clinical Practice 2011;17(4):786-793. DOI: http://dx.doi.org/10.1111/j.1365-2753.2010.01456.x

Factors influencing evidence-based physical therapy practice post-stroke: A mail survey

Salbach NM, Jaglal SB, Korner-Bitensky N, Rappolt S, Davis D. Practitioner and organizational barriers to evidence-based practice of physical therapists for people with stroke. Physical Therapy 2007;87:1284-1303. DOI: http://dx.doi.org/10.2522/ptj.20070040

Salbach NM, Guilcher SJT, Jaglal SB, Davis DA. Factors influencing information seeking by physical therapists providing stroke management. Physical Therapy 2009;89:1039-1050. DOI: http://dx.doi.org/10.2522/ptj.20090081

Salbach NM, Guilcher SJT, Jaglal SB, Davis DA. Determinants of research use in clinical decision-making among physical therapists providing services post-stroke: a cross-sectional study. Implementation Science 2010, 5:77. DOI: http://dx.doi.org/10.1186/1748-5908-5-77

Salbach NM, Guilcher SJT, Jaglal SB. Physical therapists’ perceptions and use of standardized assessments of walking ability post-stroke. Journal of Rehabilitation Medicine 2011;43:543-549. DOI: http://dx.doi.org/10.2340/16501977-0820