Challenges in applying evidence-based practice in stroke rehabilitation: a qualitative description of health professional experience in low, middle, and high-income countries

Abstract

Purpose: Evidence-based practice (EBP) is considered central to ethical, effective service delivery in rehabilitation, and the implementation of the World Health Organisation’s Rehabilitation Strategy 2030. This study aimed to explore and compare the experiences of health professionals regarding the application of EBP for stroke rehabilitation in each participant’s region and country, which provided perspectives from low, middle, and high-income countries.Methods and materials: Interviews were conducted with 12 experienced rehabilitation professionals from 12 different countries (5 high-income, 2 upper-middle income, 3 lower-middle income, and 2 low-income countries) and interpreted using qualitative descriptive analysis.Results: Nine factors influencing evidence-based stroke rehabilitation were: 1) the complexity of rehabilitation research; 2) the (ir)relevance of research to local context; 3) lack of time for EBP; 4) minimal training in EBP; 5) changing health professional behaviours; 6) poor access to resources for developing EBP; 7) influence of culture, patients, and families; 8) language barriers; and 9) lack of access to research evidence. Economic constraints contributed to many challenges; but not all challenges related to the country’s economic classification.Conclusion: A global approach is needed to share knowledge about EBP, especially scientific evidence and innovative thinking about its application to clinical practice. 

Implications for rehabilitation

• Rehabilitation professional groups should contribute to a global network to improve informal knowledge sharing and training around evidence-based practice.

• Support for training in evidence-based practice and its application needs to be developed and accessible in all countries, including low and middle-income countries.

• It is imperative that policymakers prioritise practical, evidence-based solutions for rehabilitation research in low and middle-income countries that can be effectively implemented within local settings.

• There must be solutions and increased accessibility of journal articles for those working in low and middle-income countries including those whose first language is not English.

Keywords:

• Developing countries
• evidence-based healthcare
• evidence-based practice
• evidence-based medicine
• global health
• international health problems
• stroke rehabilitation
• rehabilitation

Acknowledgements

We would like to thank the following people for their contribution to this study: Gabrielle Echkhart, Abena Tannor, Ali Yavuz Karahan, Ismalia Kebbie, Vanessa Seijas, Roshan Kumar Bishwkarma, David Alexander, Bui Thi Huong, and to our other contributors from New Zealand, England, and the United Arab Emirates.

Disclosure statement

We have no known conflicts of interest.

Additional information

Funding

No financial support was provided for this work.