Purpose:
To describe the barriers to implementation of evidence-based
recommendations (EBRs) for stroke rehabilitation experienced by nurses,
occupational therapists, physical therapists, physicians and hospital
managers.
Methods: The Stroke Canada Optimization of
Rehabilitation by Evidence project developed EBRs for arm and leg
rehabilitation after stroke. Five Canadian stroke inpatient
rehabilitation centers participated in a pilot implementation study. At
each site, a clinician was identified as the “local facilitator” to
promote the 6-month implementation. A research coordinator observed the
process. Focus groups done at completion were analyzed thematically for
barriers by two raters.
Results: A total of 79 rehabilitation
professionals (23 occupational therapists, 17 physical therapists, 23
nurses and 16 directors/managers) participated in 21 focus groups of
three to six participants each. The most commonly noted barrier to
implementation was lack of time followed by staffing issues,
training/education, therapy selection and prioritization, equipment
availability and team functioning/communication. There was variation in
perceptions of barriers across stakeholders. Nurses noted more training
and staffing issues and managers perceived fewer barriers than frontline
clinicians.
Conclusions: Rehabilitation guideline developers
should prioritize evidence for implementation and employ user-friendly
language. Guideline implementation strategies must be extremely time
efficient. Organizational approaches may be required to overcome the
barriers.
Implications for Rehabiliation
Despite increasingly strong evidence for stroke rehabilitation, there are delays in implementation into clinical practice.
This
study showed that lack of time, staffing issues, staff education,
therapy selection or prioritization, lack of equipment and team
functioning were the main barriers to implementation.
Managers and stakeholders should consider these barriers and prioritize evidence when implementing.
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