IS HIGH REPETITIVE DEVICE-ASSISTED GAIT REHABILITATION THE KEY? IMPLEMENTATION AND EFFECTIVENESS OF THE GAIT CASCADE (AN INTERNAL GUIDELINE)

Introduction: In neurorehabilitation, the improvement of walking is one of the most important goals. The importance of high-dosage therapy to influence neuroplasticity and long-term function has been highlighted by several authors [1,2], although the recommended number is rarely achieved [3]. Literature shows that device-assisted gait-training combined with conventional therapy is the most effective treatment to improve gait in neurological patients. This evidence is seldom implemented in practice [3,4,5]. Based on this gap, the aim was to develop and implement an clinical pathway for gait rehabilitation.
Methods: The Gait Cascade (GC) is based on current evidence and combined with expert opinion. Content included a definition of outcome measures, intensity parameters, and a structured implementation plan (knowledge-to-action). Feasibility was checked with the implemented frequency. The efficacy of the GC was evaluated via analysis of the outcome measures.
Outcomes: The GC includes five gait devices and the cascade application is based on the functional gait assessment. The clinical-utility-index was increased from 56%(2020) to 80%(2023). The main barriers were practicability of the treatment frequency in the rigid health-planning-system. While 90% of the treatment-team thinks the GC is important and effective, only 26% use it as described. The analysis of effectiveness shows a clinically relevant improvement in all clinical assessments in a 3-month pilot phase (p<0.0001).
Conclusion: Effective implementation presents a major challenge in clinical practice. The greatest hurdle was the practicability of frequency of the intervention due to organisational systems. Decisive facilitating factors were known “champions”, regular reminders for staff and ongoing team education.