Evidence map›Paper›PMID 41508158›Full record

ArticleImplementation science communications2026

Exploring factors influencing implementation across the explanatory-to-pragmatic trial continuum: a sequential qualitative integration of delivering higher-intensity walking exercise within inpatient stroke rehabilitation.

Suzanne Ackerley, Stanley H Hung, Lisa Sheehy, Sarah J Donkers, Polina Timofeeva, Krista L Best, Sue Peters, Sarah S Park, Béatrice Ouellet, Victor E Ezeugwu and 4 more

2 registry-linked trialsAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Implementation science communications, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01915368 nacompletednot on this map

Determining Optimal Post-Stroke Exercise (DOSE)

TypeinterventionalSponsorUniversity of British ColumbiaRan2013 to 2019Enrolled75ConditionsCerebrovascular Accident, Stroke, Cerebral Infarction, Brain InfarctionArmsStroke Management Program (SMP), Stroke Monitoring Program (SMonP), Stroke Supplementary Program (SSP)
NCT04238260 nacompletednot on this map

Enhancing Physical Therapy Best Practice for Improving Walking After Stroke

TypeinterventionalSponsorUniversity of British ColumbiaRan2021 to 2025Enrolled306ConditionsStroke, Cerebral Infarction, Brain Ischemia, Infarction, BrainArmsEnhancing Physical Therapy Usual Care, Physical Therapy Usual Care
3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Suzanne AckerleyFaculty of Health and Medicine, Health Innovation Campus, Lancaster University, Lancaster, UK.
Stanley H HungDepartment of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
Lisa SheehyBruyère Health Research Institute, Ottawa, ON, Canada.
Sarah J DonkersSchool of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
Polina TimofeevaDepartment of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
Krista L BestCentre for interdisciplinary research in rehabilitation and social integration (Cirris), Centre intégré universitaire de santé et de services sociaux de La capitale-nationale, Quebec City, QC, Canada.
Sue PetersDepartment of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
Sarah S ParkDepartment of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
Béatrice OuelletCentre for interdisciplinary research in rehabilitation and social integration (Cirris), Centre intégré universitaire de santé et de services sociaux de La capitale-nationale, Quebec City, QC, Canada.
Victor E EzeugwuDepartment of Physical Therapy, University of Alberta, Edmonton, AB, Canada.
Marie-Hélène MilotÉcole de Réadaptation, Faculté de Médecine Et Des Sciences de La Santé, Université de Sherbrooke and Research Center On Aging CIUSSS-de-L'Estrie-CHUS, Quebec, Canada.
Brodie M SakakibaraCentre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
Janice J Eng *Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
Louise A Connell *Faculty of Health and Medicine, Health Innovation Campus, Lancaster University, Lancaster, UK. l.connell2@lancaster.ac.uk.ORCID http://orcid.org/0000-0002-0629-2919

Funding

Canadian Institute of Health Research 143340
6 · The paper itself

Abstract

backgroundMany innovations with proven efficacy in randomized controlled trials encounter significant barriers to real-world implementation. Using an example from delivery of a higher-intensity walking exercise protocol within inpatient stroke rehabilitation, we explored factors influencing implementation when moving from an explanatory trial under ideal conditions to a more pragmatic trial under real-world conditions. We identified implementation strategies and practical actions for implementation into routine inpatient stroke rehabilitation.

methodsContext and perspectives of delivering higher-intensity walking exercise in the Walk 'n Watch (WnW) pragmatic trial were compared and contrasted with its predecessor, the Determining Optimal post-Stroke Exercise (DOSE) trial. The PRECIS-2 tool was used to quantify trials along the explanatory-to-pragmatic continuum. A sequential qualitative integrative approach compared perspectives from semi-structured interviews conducted with therapists and managers in the WnW trial (n = 18) to previously published therapist perspectives from the DOSE trial (n = 15). The Consolidated Framework for Implementation Research (CFIR) was used deductively. The CFIR-Expert Recommendations for Implementing Change (ERIC) matching tool was used retrospectively to identify key implementation strategies, operationalizing to practical actions employed during WnW protocol implementation.

resultsPRECIS-2 analysis demonstrated a shift towards greater pragmatism (mean (SD) domain score 2.8 (1.4) vs 4.3 (0.7)). In both trials, therapists were motivated to deliver the protocol, despite differing belief systems and staffing challenges. In the WnW trial, therapists demonstrated greater readiness for change, actively implementing protocol principles whilst modifying delivery to meet needs. Managers and champions played an important role in supporting decision-making and systems-level compatibility. Ten ERIC strategies were identified focusing on evaluating needs, ensuring team readiness, promoting adaptability and ongoing engagement. Practical actions included optimizing innovation-context fit, fostering a collective commitment and focusing on communication.

conclusionsCapitalizing on a unique longitudinal opportunity, we report consistent, evolving and emerging factors that influenced implementation, highlighting the importance of iterative consideration of context and perspectives along the explanatory-to-pragmatic continuum. Our example indicates that higher-intensity walking exercise protocols hold promise for widespread adoption in stroke rehabilitation, with local modifications for optimizing innovation-context fit. Leveraging our relatively rare pragmatic trial, we identified implementation strategies and practical actions to provide tangible support for future implementation efforts. For long-term sustainability, economic factors require consideration.

trial registrationwww. CLINICALTRIALS: gov ID: NCT01915368. www. CLINICALTRIALS: gov ID: NCT04238260.

Indexed as

AdaptationAllied healthContextFidelityIntensityPhysical therapyPRECIS-2

Identifiers

PMID41508158
PMCPMC12973730

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.