Département de réadaptation, Faculté de médecine, Université Laval, and Centre interdisciplinaire de recherche en réadaptation et en intégration sociale (CIRRIS), Quebec City, Quebec, Canada (Dr Lamontagne and Ms Marier-Deschênes); Ontario Neurotrauma Foundation, Ontario, Canada (Mss Gargaro and Kagan); Institut national d'excellence en santé et en services sociaux (INESSS), Quebec City, Quebec, Canada (Drs Truchon and Brière); Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada (Dr Bayley); Faculty of Medicine, University of Toronto (Dr Bayley); Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada (Dr Marshall); and Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) and Université de Montréal, Montreal, Quebec, Canada (Dr Swaine).
J Head Trauma Rehabil. 2018 Sep/Oct;33(5):306-316. doi: 10.1097/HTR.0000000000000430.
Appraising current practice is an important prerequisite for implementation of clinical practice guidelines (CPGs). The study objective was to determine the perceived level of implementation, priority, and feasibility of a subset of key CPG recommendations for the rehabilitation of individuals with moderate to severe traumatic brain injury (MSTBI).
Fifty-one teams at acute care and rehabilitation facilities were invited to complete an electronic survey addressing the perceived level of implementation, priority, and feasibility of 109 fundamental and priority recommendations from the CPG-MSTBI.
Forty-four clinical teams responded across 2 Canadian provinces. Most of the recommendations were deemed as "fully" or "mostly" implemented, while relative gaps in implementation were perceived in recommendations regarding coordination with mental health and addiction providers (>75% of respondents indicated low levels of implementation), "Caregivers and Families" (26%), and "Psychosocial and Adaptation Issues" (25%). Priority levels and perceived feasibility were generally high (>60% and >86%, respectively) for recommendations with low levels of implementation. Priority recommendations for implementation were identified for both acute care and rehabilitation settings in Québec and Ontario.
Assessment of clinician perception provides a helpful perspective for implementation. Exploring perceived implementation gaps based on users' needs and expectation should be a part of an implementation process.
评估当前实践是实施临床实践指南（CPG）的重要前提。本研究的目的是确定对中度至重度创伤性脑损伤（MSTBI）康复的关键 CPG 建议子集的实施、优先顺序和可行性的感知程度。
邀请 51 个急性护理和康复机构的团队完成一项电子调查，调查内容涉及对来自 CPG-MSTBI 的 109 项基本和优先建议的实施、优先顺序和可行性的感知程度。
在加拿大的 2 个省份，有 44 个临床团队做出了回应。大多数建议被认为是“完全”或“大部分”实施的，而在与心理健康和成瘾服务提供者协调方面的建议（>75%的受访者表示实施水平较低）、“照顾者和家庭”（26%）以及“心理社会和适应问题”（25%）方面，实施的差距较大。对于实施水平较低的建议，其优先顺序和感知可行性通常较高（>60%和>86%）。在安大略省和魁北克省的急性护理和康复环境中，确定了优先实施的建议。
评估临床医生的认知为实施提供了有益的视角。根据用户的需求和期望，探索感知到的实施差距应该是实施过程的一部分。
