Determining the Barriers and Facilitators to Adopting Best Practices in the Management of Poststroke Unilateral Spatial Neglect: Results of a Qualitative Study

Abstract

Background: A gap exists between best and actual management of poststroke unilateral spatial neglect (USN). Given the negative impact of USN on poststroke recovery, knowledge translation efforts are needed to optimize USN management. To date, no study has investigated the specific barriers and facilitators affecting USN management during the acute care process. Objective: To identify the facilitators and barriers that affect evidence-based practice use by occupational therapists (the primary discipline managing USN) when treating individuals with acute poststroke USN. Methods: Focus group methodology elicited information from 9 acute care occupational therapists. Results: Key barriers identified included lack of basic evidence-based practice skills specific to USN treatment and personal motivation to change current practices and engrained habits. Key facilitators included the presence of a multidisciplinary stroke team, recent graduation, and an environment with access to learning time and resources. Synthesized Web-based learning was also seen as important to uptake of best practices. Conclusion: It is estimated that upwards of 40% of patients experience poststroke USN in the acute phase, and we have evidence of poor early management. This study identified several modifiable factors that prepare the ground for the creation and testing of a multimodal knowledge translation intervention aimed at improving clinicians’ best practice management of poststroke USN.

Keywords:

• evidence-based practice
• focus groups
• hemispatial neglect
• occupational therapy
• stroke