title: Minimizing the evidence-practice gap - a prospective cohort study incorporating balance training into pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  We have recently demonstrated the efficacy of balance training in addition to Pulmonary Rehabilitation (PR) at improving measures of balance associated with an increased risk of falls in individuals with Chronic Obstructive Pulmonary Disease (COPD). Few knowledge translation (KT) projects have been conducted in rehabilitation settings. The goal of this study was to translate lessons learnt from efficacy studies of balance training into a sustainable clinical service.
  
  
  METHODS
  Health care professionals (HCPs) responsible for delivering PR were given an hour of instruction on the principles and practical application of balance training and the researchers offered advice regarding; prescription, progression and practical demonstrations during the first week. Balance training was incorporated three times a week into conventional PR programs. Following the program, HCPs participated in a focus group exploring their experiences of delivering balance training alongside PR. Service users completed satisfaction surveys as well as standardized measures of balance control. At six month follow-up, the sustainability of balance training was explored.
  
  
  RESULTS
  HCPs considered the training to be effective at improving balance and the support provided by the researchers was viewed as helpful. HCPs identified a number of strategies to facilitate balance training within PR, including; training twice a week, incorporating an interval training program for everyone enrolled in PR, providing visual aids to training and promoting independence by; providing a set program, considering the environment and initiating a home-based exercise program early. Nineteen service users completed the balance training [ten male mean (SD) age 73 (6) y]. Sixteen patients (84%) enjoyed balance training and reported that it helped them with everyday activities and 18 (95%) indicated their wish to continue with it. Scores on balance measures improved following PR that included balance training (all p < 0.05). At six month follow-up balance training is being routinely assessed and delivered as part of standardised PR.
  
  
  CONCLUSIONS
  Implementing balance training into PR programs, with support and training for HCPs, is feasible, effective and sustainable.
  
  
  BACKGROUND
  Clinical Trials ID: NCT02080442 (05/03/2014).
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada. Samantha.Harrison@westpark.org.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Harrison
authors.affiliation: Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, MA, USA. mkbeauchamp@partners.org.
authors.forename: Marla K
authors.initials: MK
authors.lastname: Beauchamp
authors.affiliation: Centre for Healthcare Innovation and Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. Kathryn.Sibley@med.umanitoba.ca.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Sibley
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada. Tamara.Araujo@westpark.org.
authors.forename: Tamara
authors.initials: T
authors.lastname: Araujo
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada. julia.marie.romano@gmail.com.
authors.forename: Julia
authors.initials: J
authors.lastname: Romano
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada. Roger.Goldstein@westpark.org.|Department of Physical Therapy, University of Toronto, Toronto, ON, Canada. Roger.Goldstein@westpark.org.|Department of Medicine, University of Toronto, Toronto, ON, Canada. Roger.Goldstein@westpark.org.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Goldstein
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada. dina.brooks@utoronto.ca.|Department of Physical Therapy, University of Toronto, Toronto, ON, Canada. dina.brooks@utoronto.ca.
authors.forename: Dina
authors.initials: D
authors.lastname: Brooks
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D002170:Canada; D003430:Cross-Sectional Studies; D055317:Evidence-Based Practice; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006282:Health Personnel; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D004856:Postural Balance / Q000502:physiology*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D011788:Quality of Life