Why allied health professionals use evidence-based clinical guidelines in stroke rehabilitation: A systematic review and meta-synthesis of qualitative studies

Abstract

Objective: To capture qualitative research about the perspectives and reasoning of allied health professionals about variability in the use of clinical guidelines in stroke rehabilitation. Data sources: Ovid Medline, Psychinfo, Cochrane, Ovid Emcare, Scopus and Web of Science. Method: The review protocol followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. Qualitative or mixed methods research that provided qualitative data about use of clinical guidelines delivered by allied health professionals in stroke rehabilitation was included. Clinical guidelines included any evidence-based documents that guided allied health stroke rehabilitation practice. All studies were screened in duplicate at title and abstract and then at full text. Included studies were appraised using the McMaster Critical Appraisal Tool. Results: Data from 850 allied health professionals in 22 qualitative research studies from seven different countries were analysed and synthesised. Four themes were developed including: context necessitates strategy, all clients are different, systemic changes are needed and need a good reason to change something. The findings aligned with the four arms of evidence-base practice. Allied health professionals use clinical guidelines when they align with their reasoning and match the ‘sweet spot’ for client goals and circumstance. Clinical guideline use is attributed to sufficient resourcing, time and motivation and a strong research culture within health systems. Conclusions: Variabilities in clinical guideline use by allied health professionals are due to their clinical reasoning, contextual factors, client characteristics and enabling health systems.

Healthcare professionals’ perceived barriers and facilitators of implementing clinical practice guidelines for stroke rehabilitation: A systematic review

“…One study 66 builds on the evidence that active and multicomponent approaches are more effective in behaviour change and uptake of clinical guidelines over the educational approach alone. 72 The findings also draw a parallel to Halls et al’s 40 review, which noted that allied health professionals working on stroke are trying to use different active and multifaceted implementation strategies.…”

“…This is echoed in previous research relating to stroke guidelines and evidencebase practice adherence. 6,39,40 There remains an over-reliance on identifying and targeting professional level barriers only especially with educational approaches. 63,68 Education in isolation is not an effective intervention for facilitating practice change.…”

“…This is echoed in previous research relating to stroke guidelines and evidence-base practice adherence. 6 , 39 , 40 …”

“… 34 – 37 Recent systematic reviews on stroke clinical practice guidelines 38 , 39 are limited in focus in acute stroke care and neither investigated healthcare professionals’ views about stroke guideline implementation. Halls et al 40 systematic review investigates guideline use in stroke rehabilitation. However, it captures only the views of allied health professionals.…”

Changes in Epidemiological Trends and Rehabilitation Usage in Neurological Diseases in Korea: Stroke

“…It is well known that intensive inpatient rehabilitation treatment during the subacute stage can reduce disabilities in stroke patients [ 1 3 ]. Clinical practice guidelines (CPGs) for stroke rehabilitation have been developed to enhance the quality of care and increase the consistency of practices across settings in many countries [ 4 5 6 ]. In Korea, CPGs for stroke rehabilitation were formulated through both an extensive review of published literature and a consensus meeting of specialists in 2009 and have been updated periodically [ 7 8 9 ].…”