Implementation of a Gait and Balance Battery of Outcome Measures in an Inpatient Rehabilitation Hospital

ImportanceStandardized outcome measure (OM) batteries are important for tracking functional progress, enhancing communication among providers, and evaluating intervention effectiveness in physical therapy. However, implementation of standardized batteries is challenging due to time constraints, documentation requirements, and limited resources. ObjectiveTo evaluate implementation of a standardized gait and balance OM battery by physical therapists for patients with stroke, brain injury, and spinal cord injury in the inpatient rehabilitation facility (IRF) setting. DesignA retrospective cohort study of 773 episodes of care at the IRF, and a quantitative survey for 22 staff physical therapists at the IRF. SettingA 75-bed IRF in the United States. InterventionsA standardized OM battery with five measures was implemented by all physical therapy teams at the IRF. Main Outcomes and MeasuresWe assessed four implementation outcomes: Penetration and Sustainability, which we assessed with retrospective cohort data of episodes of care, and Acceptability and Feasibility, which we assessed with the quantitative survey of physical therapists. ResultsThe implementation effort resulted in a significant improvement in the completion rates of all five OMs, with most measures exceeding a 70% completion rate threshold within one year after implementation. Completion rates of the entire battery increased significantly with the implementation effort, though did not reach the goal 70% completion rate. Physical therapists indicated that implementation of the standardized OM battery resulted in positive practice changes, and that barriers to completion were patients functional levels and the time required for completion. ConclusionsImplementation of a standardized OM battery is feasible in the IRF setting, though OM completion rates may improve with a more condensed battery and with integration into clinical workflows. RelevanceThis study provides a practical model for IRFs to adopt and evaluate standardized OM batteries that improve our ability to assess physical function across health systems and settings.