While the promise of wearable sensor technology to transform physical rehabilitation has been around for a number of years, the reality is that wearable sensor technology for the measurement of human movement has remained largely confined to rehabilitation research labs with limited ventures into clinical practice. The purposes of this paper are to: (1) discuss the major barriers in clinical practice and available wearable sensing technology; (2) propose benchmarks for wearable device systems that would make it feasible to implement them in clinical practice across the world and (3) evaluate a current wearable device system against the benchmarks as an example. If we can overcome the barriers and achieve the benchmarks collectively, the field of rehabilitation will move forward towards better movement interventions that produce improved function not just in the clinic or lab, but out in peoples’ homes and communities.

Background and Purpose: We addressed questions about the potential discrepancy between improvements in activity capacity and improvements in activity performance in daily life. We asked whether this discrepancy is: Common in routine, outpatient care, or an artifact of intervention studies? Unique to upper limb (UL) rehabilitation, or is it seen in walking rehabilitation too? Only seen in persons with stroke, or a broader neurorehabilitation problem? Methods: A longitudinal, observational cohort of 156 participants with stroke or Parkinson disease (PD) receiving outpatient rehabilitation at 5 clinics was assessed around admission and monthly during their episode of care. Individual, longitudinal capacity (Action Research Arm Test or walking speed) and performance (wearable sensor measurements of use ratio or steps/day) data were modeled to extract predicted change scores. Simulation methods were used to determine whether an individual's change was greater than 1 standard error. Participants were classified into categories based on whether or not they improved in capacity (C+ or C−) and/or performance (P+ or P−). Results: A majority (59%) were classified as C+P−. Smaller portions of the sample were classified as C+P+ (20%) and C−P− (21%), with 1 participant (<1%) classified as C−P+. The proportions in the C+P− category were significantly larger in the stroke (χ² = 48.7, P < 0.0001) and PD (χ² = 24.3, P < 0.0001) walking subgroups than in the stroke UL subgroup. Discussion and Conclusions: The discrepancy between improvements in capacity and performance is a problem in routine, outpatient neurorehabilitation. If performance information were available, patients and clinicians could act to address it. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A396).

Interprofessional education is becoming a requirement for accreditation of most health profession programs, therefore it is necessary to share innovative experiences so all can learn from the successes and barriers of implementation. Faculty members from five health profession programs (medicine, nursing, occupational therapy, pharmacy, and physical therapy) were tasked with developing a pilot interprofessional education experience focused on transitions of care. The result was a three-phase experience in which students individually completed online virtual cases, then came together for small- and large-group discussions, and concluded by working through a simulated patient discharge. Objectives centered on recognizing the individual’s professional role during transitions of care, identifying barriers to transitions of care, and evaluating strategies to improve safety during a transition. Outcomes were measured using an anonymous pre and post-experience survey. Twenty-three students completed the experience and identified key themes related to their profession’s role in, and barriers to a transition of care. The majority of students strongly agreed that this experience has made them more aware of the importance of interprofessional communication, and that they would recommend this pilot experience to a colleague.

Background and Purpose: Increasing activity has been shown to improve outcomes in patients receiving post–acute rehabilitation, but little is known about the activity duration and intensity that are actually occurring throughout the rehabilitative stay for older adults in skilled nursing facilities. The purpose of this study was to quantify duration and intensity of movement in older adults receiving rehabilitation in a skilled nursing facility, using 4-limb actigraphy. Methods: Observational study of 92 older adults admitted for rehabilitation services at 2 skilled nursing facilities. All participants wore actigraph accelerometers (wGT3X+) on bilateral wrists and ankles for 24 hours, inclusive of 1 session each of physical and occupational therapy. Using actigraphy data, we calculated (a) movement duration (time the dominant or noninvolved upper or lower limb was active) and (b) movement intensity (sum of activity counts per minute for the dominant or noninvolved upper or lower limb). Results: Over the 24-hour period, the lower limb moved a total median [interquartile range] of 01:10 (hours:minutes) [01:01] and the upper limb moved a total average (SD) of 04:45 (02:00). When participants did move, it was at low intensities with 61 [87] and 610 [623] activity counts per minute for lower limb out-of-therapy time and during physical therapy, respectively. For the upper limb, activity counts per minute were 689 (388) for out-of-therapy movement and 1359 (695) during physical therapy. However, neither the lower or upper limb reached a moderate-intensity level (2690-6166 counts per minute). Discussion: Older adults receiving rehabilitation in 2 skilled nursing facilities had low movement duration and movement intensity both in and out of therapy. Conclusion: Rehabilitation interventions for older adults should target and increase movement duration and intensity, during and after skilled nursing facility care.

Background: As part of the 2018 Clinical Practice Guideline (CPG): A Core Set of Outcome Measures for Adults with Neurologic Conditions Undergoing Rehabilitation, a Knowledge Translation (KT) Task Force was convened. The purpose of this short report was to (1) demonstrate the potential impact of a CPG KT Task Force through a practical example of efforts to implement a CPG into neurologic physical therapy practice and (2) describe the process to convene a KT Task Force and develop products (KT Toolkit) to facilitate implementation of the CPG. Methods: To describe the process used by the KT Task Force to develop and review a KT Toolkit for implementation of the CPG. Results: Utilizing the Knowledge-To-Action Cycle framework, eight tools were developed as part of the KT Toolkit and are available with open access to the public. Findings indicate that the Core Outcome Measures Homepage, which houses the KT Toolkit, has had greater than 70,000 views since its publication. Conclusions: This short report serves as an example of the efforts made to implement a CPG into physical therapy practice. The processes to facilitate KT and the tools developed can inform future implementation efforts and underscore the importance of having a KT Task Force to implement a CPG. Moving forward, KT Task Forces should be convened to implement new or revised guidelines. Trial registration: N/A.

BACKGROUND: Stroke is a leading cause of long-term disability, but advances for rehabilitation have lagged those for acute treatment. Large biological studies (eg, omics) may offer mechanistic insights for recovery but require collecting detailed recovery phenotypes at scale, for example, in thousands of people with minimal burden for participants and researchers. This study investigates the concurrent validity between remotely collected wearable sensor data and in-clinic assessments of motor recovery poststroke. METHODS: Utilizing a large, harmonized multisite dataset of adults at various stages of recovery poststroke, we analyzed cross-sectional (N=198; from 0 to >52 weeks) and longitudinal (N=98; from 0 to 26 weeks) changes in the use ratio, the Action Research Arm Test, and the Fugl-Meyer Assessment upper extremity subscale. The use ratio is the ratio of the time the paretic arm is active divided by the time the nonparetic arm is active. RESULTS: Our findings indicate strong concurrent validity of the use ratio, the Action Research Arm Test, and the Fugl-Meyer Assessment upper extremity subscale both cross-sectionally (differences between people) and longitudinally (changes within a person), for example, r =0.87 (95% CI, 0.80–0.91) at 0 to 6 weeks, declining to r =0.58 (95% CI, 0.39–0.72) at ≥52 weeks for correlations between use ratio and Action Research Arm Test. CONCLUSIONS: Although the use ratio strongly correlated with the Fugl-Meyer Assessment upper extremity subscale and Action Research Arm Test early after stroke, these correlations reduced with longer elapsed time poststroke. This decreasing correlation might be explained by the increasing influence that personal and environmental factors play as recovery progresses.