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

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 topic
• guidelines as topic
• evidence-based practice
• professional practice
• stroke
• stroke rehabilitation
• rehabilitation

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.

Author contributions

MLB facilitated stakeholder input to the survey design, EAL and MLB conceived the analysis, EAL, LBC, LAC, and MLB analysed and interpreted the data, all authors contributed to manuscript write-up, all authors have read and approved the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author on reasonable request.

Additional information

Funding

EAL receives salary support from a National Health and Medical Research Council Early Career Fellowship (#1138515). The following financial support was received to conduct the SRRR II meeting: Canadian Institutes of Health Research (CIHR), Canadian Stroke Trials for Optimized Results (CaSTOR) Group (note that CasTOR is a joint initiative of the Canadian Stroke Consortium and the Canadian Partnership for Stroke Recovery), Heart and Stroke Canadian Partnership for Stroke Recovery, and Florey NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia. An unrestricted educational grant was provided by Ipsen Pharma.