<p>From theory to practice: a conceptual framework to facilitate implementation of evidence in stroke rehabilitation for local context in Saudi Arabia</p>

Abstract

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.

Current physical therapy practice and implementation factors regarding the evidence-based ‘Rehabilitation of Mobility after Stroke (ReMoS)’ guideline in Germany: a cross-sectional online survey

“…time and resources), guideline characteristics (e.g. 'limited applicability of recommendations'), or organisational or personal factors with respect to patients, relatives and therapists [59,[66][67][68][69][70][71][72][73] are reported on. Building upon our results, additional approaches such as focus groups [72,73], semi-structured interviews [67,69], or both [68], should serve to broaden or further specify aspects of the ReMoS guideline.…”

How Can We Use the Promoting Action on Research in Health Services (PARIHS) Framework to Move from What We Know to What We Should Do for the Rehabilitation of a Painful Hemiplegic Shoulder (PHS)?

“… 13 , 21 , 22 Organizations play a critical role in encouraging clinical specialty participation via core special interest groups, email services, and visits to other organizations. 15 , 21 , 22 Additionally, organizations may collaborate with clinicians to create best practices. It may be possible to support the establishment of interdisciplinary local guidelines/protocols and organizational processes for service user engagement.…”

“… 22 Regular team meetings and informal interaction spaces may also facilitate sharing and learning amongst practitioners. 13 , 15 , 21 , 22 …”

“…This was accomplished by using consensus-based PHS rehabilitation recommendations and interviews to determine what variables impacted the usage of data in daily tasks Evidence-based clinical recommendations include high-quality clinical research with expert and patient feedback. [13][14][15] The three components of the PARIHS framework (evidence, context, and facilitation) 20 were linked to robust evidence in relation to PHS rehabilitation that guarantee to extracted this evidence with identify other factors (such as context, personal, and patient factors) and their impact on implementation process.…”

“…7 Numerous studies suggest that inadequate research implementation leads to unsatisfactory healthcare outcomes. [13][14][15] Time constraints, the process of disease management, patient engagement, validity, staffing concerns, training/education, treatment selection and priority, equipment availability, and team functioning/communications have all been identified as significant barriers to implementing stroke guidelines. [13][14][15] Some strategies for physiotherapy implementation have been described in the physiotherapy literature, [16][17][18] such as a theory-based guideline implementation tailored to identified barriers and facilitators, education, knowledge and experience sharing between researchers and clinicians, and institutional expertise.…”