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

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.

Automated summary

The study surveyed health professionals' awareness and perceived influencing factors of stroke rehabilitation guidelines internationally. It found that while many were aware of guidelines, there were multiple barriers to implementation. Efforts should focus on raising awareness of local guidelines in low- and middle-income countries and addressing local contextual factors to improve guideline use globally.