Do clinical guidelines guide clinical practice in stroke rehabilitation? An international survey of health professionals

Abstract

Purpose: To identify health professionals awareness of stroke rehabilitation guidelines, and factors perceived to influence guideline use internationally. Methods: Online survey study. Open-ended responses were thematically analysed, guided by the Consolidated Framework for Implementation Research. Results: Data from 833 respondents from 30 countries were included. Locally developed guidelines were available in 22 countries represented in the sample. Respondents from high-income countries were more aware of local guidelines compared with respondents from low- and middle-income countries. Local contextual factors such as management support and a culture of valuing evidence-based practice were reported to positively influence guideline use, whereas inadequate time and shortages of skilled staff inhibited the delivery of guideline-recommended care. Processes reported to improve guideline use included education, training, formation of workgroups, and audit-feedback cycles. Broader contextual factors included accountability (or lack thereof) of health professionals to deliver rehabilitation consistent with guideline recommendations. Conclusion: While many health professionals were aware of clinical guidelines, they identified multiple barriers to their implementation. Efforts should be made to raise awareness of local guidelines in low- and middle-income countries. More attention should be paid to addressing local contextual factors to improve guideline use internationally, going beyond traditional strategies focused on individual health professionals. • Systems are required so people and organisations are held accountable to deliver evidence-based care in stroke rehabilitation. • Locally developed stroke rehabilitation guidelines should be promoted to boost awareness of these guidelines in low- and middle-income countries. • In all regions, strategies to influence or adapt to the local setting, are required to optimise guideline use.