What influences the implementation of the New Zealand stroke guidelines for physiotherapists and occupational therapists?

Mudge, Suzie; Hart, Anna; Murugan, Sankaran; Kersten, Paula

doi:10.3109/09638288.2016.1146361

Cited by 17 publications

(66 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The identification of barriers and facilitators to implementing evidence-based practice within stroke rehabilitation have previously been informed by the TDF (McCluskey et al, 2013;Phillips et al, 2015;Shrubsole et al, 2018). Alternately, thematic analysis has also been adopted as a means of identifying factors influencing behaviour change (Foster et al, 2014;Miao, Power, & O'Halloran, 2015;Mudge, Hart, Murugan, & Kersten, 2017). This current study has however incorporated both forms of analysis, contributing to a process of identifying relevant TDF domains (Cane, O'Connor, et al, 2012), and exploring their relationships to each other.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly to existing literature, this study emphasised the importance of easily accessible and practical recommendations in order to achieve cultural change and successful implementation of evidence-based practice. A study investigating the implementation of Australian and New Zealand stroke guidelines identified common themes influencing implementation including guideline characteristics and making implementation explicit (Miao et al, 2015;Mudge et al, 2017). As a result, if the challenges of implementation are not addressed, current literature suggests that an evidence-practice gap will remain.…”

Section: Advancements In Communication Technologiesmentioning

confidence: 99%

See 1 more Smart Citation

Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries

et al. 2019

View full text Add to dashboard Cite

M. ORCID: 0000-0001-7344-2262, Pritchard, M. and Le Dorze, Guylaine (2019). Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries. Aphasiology, Increasing the intensity and comprehensiveness of aphasia services:Identification of key factors influencing implementation across six countries. AbstractBackground: Aphasia services are currently faced by increasing evidence for therapy of greater intensity and comprehensiveness. Intensive Comprehensive Aphasia Programs (ICAPs) combine these elements in an evidence-based, time limited group program. The incorporation of new service delivery models in routine clinical practice is however likely to pose challenges for both the service provider and administering clinicians. This program of research aims to identify these challenges from the perspective of aphasia clinicians from six countries and will seek to trial potential solutions. Continual advancements in global communication technologies suggest that solutions will be easily shared and accessed across multiple countries. Aims:To identify the perceived and experienced barriers and facilitators to the implementation of 1) intensive aphasia services, 2) comprehensive aphasia services, and 3) ICAPs, from aphasia clinicians across six countries. Methods and procedures:A qualitative enquiry approach included data from six focus groups (n=34 participants) in Australia, New Zealand, Canada, United States of America (USA), United Kingdom (UK), and Ireland. A thematic analysis of focus group data was informed by the Theoretical Domains Framework (TDF). Outcomes and results: Five prominent theoretical domains from the TDF influenced the implementation of all three aphasia service types across participating countries: environmental context and resources, beliefs about consequences, social/professional role and identity, skills, and knowledge. Four overarching themes assisted the identification and explanation of the key barriers and facilitators: 1. Collaboration, joint initiatives and partnerships, 2. Advocacy, the promotion of aphasia services and evidence-based practice, 3. Innovation, the ability to problem solve challenges, and 4. Culture, the influence of underlying values. Conclusions:The results of this study will inform the development of a theoretically informed intervention to improve health services' adherence to aphasia best practice recommendations.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Advancements In Communication Technologiesmentioning

confidence: 99%

Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Consistent with clinical areas outside of stroke rehabilitation (Cochrane et al, 2007), most previous research has focused exclusively on barriers to guideline adherence. Stroke rehabilitation therapists report that the lack of time (Bayley et al, 2012), staffing issues (Bayley et al, 2012;Munce et al, 2017), staff skill levels and knowledge gaps (Baatiema et al, 2017;Bayley et al, 2012;McCluskey, Vratsistas-Curto, & Schurr, 2013;Mudge, Hart, Murugan, & Kersten, 2017), difficulty selecting or prioritising between therapies (Bayley et al, 2012) and access to resources (including protocols) (Baatiema et al, 2017;Bayley et al, 2012;McCluskey et al, 2013;Mudge et al, 2017) act as barriers to delivering stroke rehabilitation in accordance with guideline recommendations. But just as teams face barriers, so too do they possess strengths.…”

Section: Introductionmentioning

confidence: 99%

Increasing the uptake of stroke upper limb guideline recommendations with occupational therapists and physiotherapists. A qualitative study using the Theoretical Domains Framework

Jolliffe

Hoffmann

Lannin

2019

Aus Occup Therapy J

View full text Add to dashboard Cite

Introduction Despite the availability of stroke clinical practice guidelines and acceptance by therapists that guidelines contain ‘best practice’ recommendations, compliance remains low. While previous studies have explored barriers associated with implementing rehabilitation guidelines in general, it remains unknown if these barriers are applicable to upper limb rehabilitation specifically. To plan effective implementation activities, key motivators and barriers to use should be identified. Method To investigate occupational and physiotherapists’ perceptions of motivators and barriers to using upper limb clinical practice guideline recommendations in stroke rehabilitation, a mixed‐method study was conducted. Using an online survey and semi‐structured focus groups, physiotherapists and occupational therapists working in one of six stroke rehabilitation teams in Melbourne, Australia were invited to participate. Survey data were analysed using descriptive statistics, and thematic coding of free‐text responses. Focus groups were transcribed, thematically coded and mapped against the Theoretical Domains Framework. Results Forty‐six participants completed the survey and 29 participated in the focus groups. Key motivators to use guideline recommendations included past experience with specific interventions, availability of required resources and an enabling workplace culture. Barriers included: limited training/skills in specific interventions, the complexity of intervention protocols, and beliefs about intervention effectiveness. Lack of accountability was highlighted and therapists perceived they are rarely checked for quality assurance purposes regarding guideline adherence. Conclusion Therapists identified that both motivators and barriers to implementing best‐practice upper limb rehabilitation occur largely at the levels of the individual and the environment. As such, intervention efforts should focus at both these levels to facilitate change.

show abstract

“…In contrast, the extended clinicians' resource (interactive pdf) was barely used with limited time and format (necessitating deliberate time at a computer) reported as the main reasons it was not used. Time is universally named as a barrier in any change or service improvement initiative [33][34][35][36], however NPT provides further insight into how time acts as a barrier linking it with cognitive participation. 'Not enough time' can be understood as the shorthand clinicians use when they are not prepared to invest time into understanding and/or operationalising a new practice.…”

Section: Discussionmentioning

confidence: 99%

Pilot trial of The Living Well Toolkit: qualitative analysis and implications for refinement and future implementation

Mudge

Sezier

Payne

et al. 2020

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background: Following a neurological event, people's long-term health and well-being is hampered by a system that struggles to deliver person-centred communication and coordinated care and fails to harness individual and family capability to live well with the condition. We aimed to implement and evaluate a toolkit package to support these processes for people with long-term neurological conditions. Methods: This is a multi-phased study drawing on the principles of participatory research. In this pilot phase, the toolkit package was introduced to clinicians, who introduced it to clients in four neurorehabilitation settings (inpatient and community-based). Individual and focus group interviews were carried out with clients (n = 10) and clinicians (n = 9). Data were categorised by the four components of Normalisation Process Theory (NPT), and data within each component was then coded inductively. This analysis was used to inform revisions to the toolkit package and wider implementation processes. Results: There was widespread support for the principles underpinning the toolkit package from clients and clinicians. However, it was less clear how the client toolkit could support these principles in clinical practice which impacted buy-in. The flexibility of use of the client toolkit, which we encouraged, made it difficult for clinicians and clients to be clear about its purpose and for clinicians to operationalise in practice. Clinicians and clients identified a number of barriers that limited the time, energy and work users were able or prepared to invest, to the extent that uptake of the toolkit package was modest. Use of the toolkit package appeared more likely when clinicians perceived it to augment existing processes (e.g. goal setting) rather than detract from 'doing' therapy. This analysis was used to inform revisions to the toolkit package, including simplification of the client toolkit, development of videos with examples of use and a modular and reflective training package for clinical services. The refinements were intended to improve sense-making and minimise the cognitive barriers associated with implementation of a new intervention. Conclusion: Understanding how supporting the client toolkit could add value to the therapeutic encounter was necessary for clinicians to invest time and perceive the worth of the toolkit package.

show abstract

What influences the implementation of the New Zealand stroke guidelines for physiotherapists and occupational therapists?

Cited by 17 publications

References 16 publications

Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries

Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries

Increasing the uptake of stroke upper limb guideline recommendations with occupational therapists and physiotherapists. A qualitative study using the Theoretical Domains Framework

Pilot trial of The Living Well Toolkit: qualitative analysis and implications for refinement and future implementation

Contact Info

Product

Resources

About