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Meta-Analysis
. 2023 May;37(5):701-712.
doi: 10.1177/02692155221141036. Epub 2022 Dec 7.

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

Adrienne Cormican  1 , Shashivadan P Hirani  2 , Eamonn McKeown  3
Affiliations
Meta-Analysis

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

Adrienne Cormican et al. Clin Rehabil. 2023 May.

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.

Keywords: barriers; clinical practice guideline; facilitators; healthcare professional; stroke rehabilitation.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preferred reporting item for systematic reviews and meta-analysis (PRISMA) flowchart of the study retrieval and section process.
Figure 2.
Figure 2.
Domain of influential factors (perceived barriers and/or facilitators) under themes.
See this image and copyright information in PMC

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References

    1. Brusamento S, Legido-Quigley H, Panteli D, et al. Assessing the effectiveness of strategies to implement clinical guidelines for the management of chronic diseases at primary care level in EU member states: A systematic review. Health Policy 2012; 107: 168–183. - PubMed
    1. Hubbard IJ, Harris D, Kilkenny MF, et al. Adherence to clinical guidelines improves patient outcomes in Australian audit of stroke rehabilitation practice. Arch Phys Med Rehabil 2012; 93: 965–971. - PubMed
    1. Cadilhac D, Ibrahim J, Pearce D, et al. Multicenter comparison of processes of care between stroke units and conventional care wards in Australia. Stroke 2004; 35: 1035–1040. - PubMed
    1. Duncan PW, Horner RD, Reker DN, et al. Adherence to post-acute rehabilitation guidelines is associated with functional recovery in stroke. Stroke 2002; 33: 167–178. - PubMed
    1. Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 2013; 9: CD000197. - PMC - PubMed