Adherence of physical therapy with clinical practice guidelines for the rehabilitation of stroke in an active inpatient setting

Abstract

Background: Clinical guidelines are systematically developed statements designed to help practitioners and patients to make decisions about appropriate health care. Clinical practice guideline adherence analysis is the best way to fine tune the best practices in a health care industry with international benchmarks. Objective: To assess the physical therapist's adherence to structured stroke clinical practice guidelines in an active inpatient rehabilitation center in Qatar. Setting: Department of Physical therapy in the stroke rehabilitation tertiary referral hospital in Qatar. Method: A retrospective chart audit was performed on the clinical records of 216 stroke patients discharged from the active inpatient stroke rehabilitation unit with a diagnosis of stroke in 2016. The audit check list was structured to record the adherence of the assessment, goal settings and the management domains as per the "Physical Therapy After Acute Stroke" (PAAS) guideline. Result: Of the 216 case files identified during the initial search, 127 files were ultimately included in the audit. Overall adherence to the clinical practice guideline was 71%, a comparable rate with the studies analyzing the same in various international health care facilities. Domains which were shared by interdisciplinary teams than managed by physical therapy alone and treatments utilizing sophisticated technology had lower adherence with the guideline. A detailed strength and weakness breakdown were then conducted. Conclusion: This audit provides an initial picture of the current adherence of physical therapy assessment and management with the stroke physical therapy guideline at a tertiary rehabilitation hospital in the state of Qatar. An evaluation of the guideline adherence and practice variations helps to fine tune the physical therapy care to a highest possible standard of practice. Implications for Rehabilitation • An evaluation of the guideline adherence and practice variations helps to fine tune the rehabilitation care to the highest possible standard of practice. • Proper assessments of the relationship between the process of rehabilitation care and outcomes with a comprehensive set of process indicators will improve the quality of the care. • An agreement needs to be established between rehabilitation teams engage in interdisciplinary stroke care regarding the shared responsibilities and team functioning. • It is recommendable to develop a specialty based clinical practice guidelines that can be aligned at a higher 'comprehensive rehabilitation level' to provide the best possible and evidence based stroke care.

Keywords: Stroke; guidelines; physical therapy.