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.
No comments:
Post a Comment