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

The complete problem in stroke is in full display here. 'GUIDELINES' NOT PROTOCOLS.  Until we get to protocols, survivors will never regularly get to 100% recovery.  I should get blasted by every stroke professional that I don't know what the hell I'm talking about.  Tell me exactly where I'm wrong and I'll refute your argument.  That is not arrogance, arrogance is commenting without knowledge.

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

Elizabeth A. Lynch, Louise A. Connell, Lilian B. Carvalho & Marie-Louise Bird

Received 20 Jul 2020, Accepted 12 Feb 2021, Published online: 02 Mar 2021

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• https://doi.org/10.1080/09638288.2021.1891304
  

 

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Abstract

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.

Keywords:

Practice guidelines as topicguidelines as topicevidence-based practiceprofessional practicestrokestroke rehabilitationrehabilitation

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Acknowledgements

The authors acknowledge Julie Bernhardt for convening the second Stroke Rehabilitation and Recovery Roundtable (SRRR II), Dale Corbett for organizing the meeting, and Farrell Leibovitch for moderating discussions. We also acknowledge the SRRR2 knowledge translation working group: Janice J Eng, Erin Godecke, Tammy C Hoffmann, Carole Laurin, Olumide A Olaoye, John Solomon, Robert Teasell, Caroline L Watkins and Marion F Walker.