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

Abstract

Objective To identify healthcare professionals’ perceived barriers and facilitators to clinical practice guideline implementation within stroke rehabilitation. Data sources CINAHL, MEDLINE, EMBASE, AMED, Cochrane library, Academic Search Complete and Scopus. Additional papers were identified through hand searching. Review methods The review followed the Preferred Reporting Item for Systematic Reviews and Meta-Analysis Protocols systematic review approach. Any empirical research that provided qualitative data on healthcare professionals’ perceived factors influencing clinical guideline implementation in stroke rehabilitation was included. One reviewer screened all titles and abstract reviews ( n = 669). Another two reviewers independently screened 30% of title and abstract reviews, followed by full-text reviews ( n = 61). Study quality was assessed using the mixed-method appraisal tool. Results Data from 10 qualitative, six quantitative and six mixed-method studies published between 2000 and 2022, involving 1576 participants in total, were analysed and synthesised using modified thematic synthesis approach. The majority of participants were therapists n = 1297 (occupational therapists, physiotherapists, speech and language therapists). Organisational factors (time constraints, resources) alongside healthcare professionals’ lack of knowledge and skills were the most cited barriers to guideline implementation. Contradictory attitudes and beliefs towards stroke guidelines applicability to real-life clinical practice and their evidence base were reported. Organisational support in the form of training, local protocols, performance monitoring and leadership were reported as perceived facilitators. Conclusion Barriers and facilitators are multifactorial and were identified at guideline, individual, team and organisational levels. There is a need to translate perceived barriers and facilitators into implementation interventions especially addressing organisational-level barriers.

Clinical Practice Guidelines (CPGs) for stroke rehabilitation from Low- and Middle-Income Countries (LMICs): Protocol for systematic review

“…Despite the evident benefits of stroke guidelines, these are underutilized in clinical practice which compromises patient care and recovery [25][26][27]. Lack of healthcare professionals' competence, time constraints, lack of resources and supporting organizational procedures are PLOS ONE some of the factors that limit the uptake and utilization of CPGs [10]. Therefore, successful implementation of CPGs requires dissemination of the guidelines, adequate training for healthcare professionals and aligning the organization services to evidence-based recommendations [10].…”

“…Previous reviews have established an association between adherence to CPGs and positive outcomes such as mobility and independence in activities of daily living after stroke [7,8]. Even though, the evidence suggests implementation of CPGs for better quality of care, it is seen that these are underutilized due to lack of knowledge and skills as well as time and resources constraints among healthcare professionals [10]. Moreover, the lack of specificity, clinical applicability, regional adaptability, knowledge translation and program implementation have caused poorer uptake of CPGs into practice in LMICs [11][12][13].…”

Nursing Interns' Orientation Program: A Predictor of Improving Nursing Interns' Knowledge About Professional Nursing Practice

“…Additionally, there was a highly statistically significant difference between nursing interns' knowledge related to EJNHS Vol. 4 Table (11) declared that the majority of study sample (98.3% & 97.2%) had satisfactory knowledge level related to international patient safety goals in the first and second follow up. And, there was no statistically significant difference between nursing interns' knowledge concerned with international patient safety goals in the ( 1 st & 2 nd ) follow up after program implementation (p>0.05).…”

Current trends and future perspectives of stroke management through integrating health care team and nanodrug delivery strategy

“…The professional stroke care team is a vital part of stroke emergency medical staff team, which is very valuable in increasing the thrombolysis rate and decreasing the disability rate and stroke mortality. The UK, USA, and other developed countries have settled a wide range of advanced practitioner nurse groups regarding stroke, such as specialized emergency and specialized rehabilitation nurses, greatly influencing the management and rehabilitation of stroke sufferers ( Cormican et al, 2023 ; Maciel Barbosa et al, 2023 ). Accordingly, stroke as a complicated clinical condition obligates health experts to benefit from their specialist knowledge and skills for the stroke survivors.…”