Clinical education alone is sufficient to improve strength training exercise prescription.

Abstract

Background: A large body of evidence demonstrates that strength training has been ineffective for improving walking outcomes in adults with neurological conditions. Strength training is already prioritized during the rehabilitation phase, yet despite significant improvements in muscle strength, there has been limited translation to improved ability to walk. This translation project aimed to bridge two large evidence-practice gaps to improve exercise prescription and achieve better walking outcomes. Method: A training seminar was conducted at 12 rehabilitation facilities with 178 clinicians. Current practice, knowledge and barriers to exercise were assessed by observation and questionnaire prior and immediately after the seminar, and at three-month follow-up. Additionally, post-seminar support and mentoring was randomly provided to half of the rehabilitation facilities using a cluster randomised controlled trial (RCT) design to determine the impact of additional implementation support. Results: The seminar led to significant improvements in clinician knowledge of the biomechanics of gait and strength training, the amount of ballistic (t = -2.38; p = .04) and conventional (t = -2.30; p = .04) strength training being prescribed. However, ongoing post-seminar support and mentoring was not associated with any additional benefits F(1, 9) = .05, p = .83, partial eta squared = .01. Further, improved exercise prescription occurred in the absence of any change to perceived barriers. Conclusion: The training seminar led to significant improvements in the time spent in ballistic and conventional strength training. There was no further benefit obtained from the additional post-seminar support. The seminar led to improved knowledge and significantly greater time spent prescribing task-specific strengthening exercises.