Introduction Implementing evidence into practice is a global priority with implications for patients, researchers, practitioners and policy-makers (stakeholders). The national clinical guideline (NCG) for stroke is one of the most important sources of robust evidence. However, implementation within real practice is often slow to respond. The knowledge to action (KTA) framework is one of several frameworks to facilitate implementation and enable evidence to be put into operation. This study aims to develop a conceptual framework to understand the process of implementation of an NCG for stroke in the local context of physiotherapy practice in the Kingdom of Saudi Arabia. Methods A qualitative–quantitative mixed methods study was conducted. The first method (panel meetings, 10 expert physiotherapists) was to chart the main concepts/domains of physiotherapy practice in the UK NCG for stroke. Drawing on panel meeting findings, 75 recommendations were released as an online questionnaire to 35 Saudi stroke specialist physiotherapists. This was followed by a focus group (second method) to capture the process of implementation of NCG for stroke in the Kingdom of Saudi Arabia. Results Sixty-one recommendations were accepted to be applied in real practice, whereas only 14 recommendations were rejected. The paper presents the first empirically derived framework that establishes the contribution of physiotherapy to stroke rehabilitation. This framework characterizes the real-world nature of the implementation of NCGs for stroke within physiotherapy practice. This framework reaffirms the importance of supportive organizational culture, the specific need of end users, patient factors, and finally transferability of the evidence. Discussion This conceptual framework appears to provide a reasonable approach for the development of implementation strategies for physiotherapist practice in stroke rehabilitation. Furthermore, it might be the first that reflects the real value of the KTA framework and tests it empirically. Conclusion The finding of this study provides a useful comprehensive framework to implement existing NCGs for stroke.
Background Parkinson’s disease (PD) is considered a neurological disease with a high prevalence rate among population. One of its main problems is recurrent fall which has numerous contributing factors such as history of fall, fear of falling, gait deficits, impaired balance, poor functional mobility, and muscle weakness. Objective To review and explore the focus/nature of interventions which target the role of physiotherapy preventing fall in patients with PD. Method A scoping review was led dependent on Arksey and O’Malley as discussed by Wood et al. (2002). This paper based on this structure to perceive intervention studies have been embraced in physiotherapy to prevent fall after Parkinson’s disease. The search included various databases. The referencing arrangements of every pertinent paper were additionally filtered for more studies. Findings A total of 173 articles were included, 39 of which met the eligibility criteria. Fifteen studies reported on the direct impact of physiotherapy on fall, while the rest examined the impacts of physiotherapy on factors that are associated with fall. Different outcomes, interventions types, and duration were used in these studies. Findings showed a favorable result of physiotherapy on fall and near fall incidence, balance, gait, functional mobility, muscle strength, and fear of falling. Conclusion Physiotherapy has the possibility to decrease fall incidence and fall risk in people with PD. However, the heterogeneity in the patients’ selection, intervention studies, outcome measures chosen, time since the onset of disease, variation in intensity, and duration of treatment between included studies make the comparisons difficult. Consequently, more studies are needed on best intervention.
Introduction Several theoretical frameworks currently promote the evidence-based clinical practice. One of these is Promoting Action on Research Implementation in Health Services (PARIHS) framework. However, The PARIHS framework emphasizes the use and implementation of pre-existing knowledge. This study aims to integrate of PARIHS conceptual framework to categorize evidence, context, and facilitation elements for the successful implementation of evidence-based painful hemiplegic shoulder (PHS) rehabilitation. Methods Stroke therapists (n=21) were interviewed to elicit important PHS rehabilitation concepts. Following that, a consensus approach was undertaken to tailor PHS recommendations to the local context. All consensus recommendations have been included in the PARIHS framework. The consensus level was set at 75% or more. Results The interviews revealed four broad themes of PHS rehabilitation, each further subdivided. Based on the themes and subthemes, 74 recommendations were deemed pertinent to PSH rehabilitation from a reliable source. Out of 74 recommendations, 63 recommendations reach the consensus level for PHS practice. Secondary prevention of PHS (n=10), assessment (n=14), PHS care management (n=19), and service delivery (n=20). A consensus was not reached for the remaining 11 recommendations. Each recommended guideline was integrated into the appropriate element of the PARIHS framework as follows: evidence (28), context (18), and facilitation (17). Discussion The findings showed how the PARIHS framework has been configured to empirically support the implementation of robust stroke rehabilitation recommendations in the field of rehabilitation. Using an implementation intervention theory (for example, PARIHS) as a guide, provide a thorough picture of the many levels that may affect implementation requirements. Conclusion Many prior studies on evidence-based stroke rehabilitation in physical therapy practice lacked knowledge of translation theories. This result illustrates how to use an intervention implementation (such as PARIHS) to enhance evidence-based practice implementation in routine stroke rehabilitation. Further study is required for the clinical use of the PARIHS framework.
Background: In Saudi Arabia, national evidence-based clinical guidelines (NCG) were created based for healthcare interventions. However, clinicians appear to be slow to incorporate the evidence into practice. As a result, there exists a time-gap between the gathering and presentation of evidence for best practice and the use of that evidence by clinicians. It becomes, therefore, imperative to investigate the gap between the research evidence and clinical practice. The knowledge to action (KTA) framework is available to facilitate the implementation of research evidence. This framework incorporates the theory of tailoring, a concept that is intended to create a fit between the evidence for the intervention and its use by the clinician. Unfortunately, the process of tailoring stills awaits clear guidelines on how it should be implemented. Consequently, this study presents hitherto unknown strategies for using novel methods, which reflect the particular role of the KTA framework in tailoring recommendations. Aim: The purpose of this study is to examine the use of the UK National Clinical Guidelines for Stroke as a clinical tool for tailoring evidence around upper extremity (UE) rehabilitation after a stroke. Methods: This study used a mixed methods (consensus approach), which includes a survey (n = 26) and nominal group meeting (NGM) with physiotherapists (n=15). Result: The first part of this study (survey) showed that 59 items (recommendations) from the UK National Clinical Guidelines for Stroke around UE post-stroke rehabilitation were accepted as consensus. Of these fifty-nine items, only 5 were rated as “no consensus.” In addition, of all the items that had been included, not a single one was rejected. The results led to three groups of recommendations based on the agreed median scores. These are as follow: lack of agreement (no consensus), highest consensus with tightest range of scores, or lowest consensus with widest range of scores. The second part of this study (NGM) explores four themes, which appeared to significantly influence the concept of “tailoring” and the participants’ ways of thinking. Conclusion: This study illustrates the role of tailoring in bridging the time-gap between the evidence and its implementation in the clinical setting. The study also provides more clarification about the role of tailoring and outlines the steps required to effectively investigate it.
Background and Purpose: Stroke is a major cause of disability and the third leading cause of death worldwide. Clinical practice guidelines for stroke rehabilitation identify stroke physiotherapists as an essential interdisciplinary team member to minimize residual impairments and disability, thereby improving the patient's ability to execute daily tasks. This article uses an existing American survey to compare Saudi physiotherapists' current practice and preferred interventions in stroke rehabilitation with their counterparts in other countries. Method: An electronic survey was sent between September and October 2020 to physiotherapists (n = 287) treating persons with stroke in Saudi Arabia. The questionnaire consisted of items related to stroke rehabilitation, including treatment approach, the goal of interventions, management of tone, facilitation of movement, function, and improved motor control. Chi-square tests (χ2) were used to test any associations between physiotherapists' responses with respect to their demographic characteristics. Quantitative data analysis was conducted using SPSS. Results: A total of 197 participants returned completed questionnaires (68.6%). Participants were asked which methods of stroke treatment they had practiced in their profession and which methods had been taught in school training. The Bobath/neurodevelopmental treatment (NDT) approach was the most commonly known approach in practice (77.66%), followed by the proprioceptive neuromuscular facilitation/Brunnstrom and motor relearning program (63.45%, 25.38%, respectively). The results showed a significant relationship between Saudi physiotherapists' current practice and the aim of treatment and function (P < .05). In general, respondents have agreed on preferred treatment approaches, with the majority referring to the Bobath/NDT method, although variation is observed between participants in some sections of the survey. The preferred treatment was based on the frequency of responses of the participants. Discussion and Conclusion: Variation has been observed between therapists regarding treatment applications in stroke rehabilitation. The current findings emphasize the need to investigate how and why practitioners use or do not use evidence in this area (such as national stroke guidelines). Future studies might need to engage Saudi stroke physiotherapists to find suitable ways to close the gap between the evidence for best practice and the use of evidence within day-to-day practices.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.