ArticlePM & R : the journal of injury, function, and rehabilitation2025
Systematic development of an implementation strategy to promote high-intensity rehabilitation uptake in skilled nursing facilities.
Article in PM & R : the journal of injury, function, and rehabilitation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- From theory to practice: A mixed-method evaluation of a program to implement high-intensity rehabilitation in skilled nursing facilities.Physical therapy · 2026Article
- An introduction to implementation science in rehabilitation medicine.PM & R : the journal of injury, function, and rehabilitation · 2025Article
- Using the implementation research logic model to examine high-intensity resistance rehabilitation implementation in skilled nursing facilities: a mixed methods multi-site case study.Implementation science communications · 2025Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundEffective implementation of rehabilitation research into clinical practice is imperative to optimize patient outcomes; however, limitations persist. A systematic approach to develop implementation strategies can address known limitations.
objectiveTo detail the systematic process for developing a strategy to implement high-intensity resistance rehabilitation (HIR) in skilled nursing facilities (SNFs), to be evaluated in future pragmatic trials.
designExpert-informed, theory-driven development study.
settingAcademic research institute.
participantsAn expert panel of clinician-researchers (n = 5) and SNF clinicians (n = 4) with experience implementing HIR collaborated on strategy development.
interventionsDevelopment followed steps of implementation mapping: (1) identifying barriers and facilitators, (2) defining performance objectives, (3) selecting theory and evidence to develop the strategy, (4) producing the implementation strategy, and (5) planning for evaluation. Panel consensus meetings were held throughout the process. MAIN OUTCOME MEASURE(S): Not applicable.
resultsBarriers and facilitators were identified at patient, clinician, and facility levels. Performance objectives included: (1) screening all patients for suitability, (2) dosing rehabilitation interventions at a high intensity for appropriate patients, (3) monitoring and adjusting dosage per patient response, and (4) progressing patients each session. Adult learning theories, social cognitive theory, and a review of the literature on effective implementation strategies guided development of a multicomponent implementation strategy: (1) train and educate clinicians (e.g., online modules); (2) provide interactive assistance (e.g., external implementation facilitator, check-ins); (3) support clinicians (e.g., job aids); and (4) change infrastructure (e.g., equipment provision). An evaluation plan was constructed.
conclusionThis work illustrates a systematic approach, guided by implementation, adult learning, and behavior change principles, for developing an implementation strategy to promote HIR implementation in diverse SNFs. Health care leaders, clinicians, and researchers can replicate this approach to enhance rehabilitation practices, improving patient care and outcomes. Future work will evaluate this strategy for HIR implementation in SNFs.
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