TY - JOUR

T1 - Do clinical guidelines guide clinical practice in stroke rehabilitation? An international survey of health professionals

AU - Lynch, Elizabeth A.

AU - Connell, Louise A.

AU - Carvalho, Lilian B.

AU - Bird, Marie Louise

PY - 2022/7/31

Y1 - 2022/7/31

N2 - Purpose: To identify health professionals awareness of stroke rehabilitation guidelines, and factors perceived to influence guideline use internationally. Methods: Online survey study. Open-ended responses were thematically analysed, guided by the Consolidated Framework for Implementation Research. Results: Data from 833 respondents from 30 countries were included. Locally developed guidelines were available in 22 countries represented in the sample. Respondents from high-income countries were more aware of local guidelines compared with respondents from low- and middle-income countries. Local contextual factors such as management support and a culture of valuing evidence-based practice were reported to positively influence guideline use, whereas inadequate time and shortages of skilled staff inhibited the delivery of guideline-recommended care. Processes reported to improve guideline use included education, training, formation of workgroups, and audit-feedback cycles. Broader contextual factors included accountability (or lack thereof) of health professionals to deliver rehabilitation consistent with guideline recommendations. Conclusion: While many health professionals were aware of clinical guidelines, they identified multiple barriers to their implementation. Efforts should be made to raise awareness of local guidelines in low- and middle-income countries. More attention should be paid to addressing local contextual factors to improve guideline use internationally, going beyond traditional strategies focused on individual health professionals.IMPLICATIONS FOR REHABILITATION Systems are required so people and organisations are held accountable to deliver evidence-based care in stroke rehabilitation. Locally developed stroke rehabilitation guidelines should be promoted to boost awareness of these guidelines in low- and middle-income countries. In all regions, strategies to influence or adapt to the local setting, are required to optimise guideline use.

AB - Purpose: To identify health professionals awareness of stroke rehabilitation guidelines, and factors perceived to influence guideline use internationally. Methods: Online survey study. Open-ended responses were thematically analysed, guided by the Consolidated Framework for Implementation Research. Results: Data from 833 respondents from 30 countries were included. Locally developed guidelines were available in 22 countries represented in the sample. Respondents from high-income countries were more aware of local guidelines compared with respondents from low- and middle-income countries. Local contextual factors such as management support and a culture of valuing evidence-based practice were reported to positively influence guideline use, whereas inadequate time and shortages of skilled staff inhibited the delivery of guideline-recommended care. Processes reported to improve guideline use included education, training, formation of workgroups, and audit-feedback cycles. Broader contextual factors included accountability (or lack thereof) of health professionals to deliver rehabilitation consistent with guideline recommendations. Conclusion: While many health professionals were aware of clinical guidelines, they identified multiple barriers to their implementation. Efforts should be made to raise awareness of local guidelines in low- and middle-income countries. More attention should be paid to addressing local contextual factors to improve guideline use internationally, going beyond traditional strategies focused on individual health professionals.IMPLICATIONS FOR REHABILITATION Systems are required so people and organisations are held accountable to deliver evidence-based care in stroke rehabilitation. Locally developed stroke rehabilitation guidelines should be promoted to boost awareness of these guidelines in low- and middle-income countries. In all regions, strategies to influence or adapt to the local setting, are required to optimise guideline use.

KW - evidence-based practice

KW - guidelines as topic

KW - Practice guidelines as topic

KW - professional practice

KW - rehabilitation

KW - stroke

KW - stroke rehabilitation

U2 - 10.1080/09638288.2021.1891304

DO - 10.1080/09638288.2021.1891304

M3 - Journal article

C2 - 33651965

AN - SCOPUS:85135211485

VL - 44

SP - 4118

EP - 4125

JO - Disability and Rehabilitation

JF - Disability and Rehabilitation

SN - 0963-8288

IS - 15

ER -