Jolliffe Laura, Hoffmann Tammy, Lannin Natasha A
School of Allied Health (Occupational Therapy), College of Science, Health & Engineering, La Trobe University, Melbourne, Australia.
Occupational Therapy Department, Alfred Health, Melbourne, Australia.
Aust Occup Ther J. 2019 Oct;66(5):603-616. doi: 10.1111/1440-1630.12599. Epub 2019 Jul 23.
Despite the availability of stroke clinical practice guidelines and acceptance by therapists that guidelines contain 'best practice' recommendations, compliance remains low. While previous studies have explored barriers associated with implementing rehabilitation guidelines in general, it remains unknown if these barriers are applicable to upper limb rehabilitation specifically. To plan effective implementation activities, key motivators and barriers to use should be identified.
To investigate occupational and physiotherapists' perceptions of motivators and barriers to using upper limb clinical practice guideline recommendations in stroke rehabilitation, a mixed-method study was conducted. Using an online survey and semi-structured focus groups, physiotherapists and occupational therapists working in one of six stroke rehabilitation teams in Melbourne, Australia were invited to participate. Survey data were analysed using descriptive statistics, and thematic coding of free-text responses. Focus groups were transcribed, thematically coded and mapped against the Theoretical Domains Framework.
Forty-six participants completed the survey and 29 participated in the focus groups. Key motivators to use guideline recommendations included past experience with specific interventions, availability of required resources and an enabling workplace culture. Barriers included: limited training/skills in specific interventions, the complexity of intervention protocols, and beliefs about intervention effectiveness. Lack of accountability was highlighted and therapists perceived they are rarely checked for quality assurance purposes regarding guideline adherence.
Therapists identified that both motivators and barriers to implementing best-practice upper limb rehabilitation occur largely at the levels of the individual and the environment. As such, intervention efforts should focus at both these levels to facilitate change.
尽管有中风临床实践指南，且治疗师认可指南包含“最佳实践”建议，但依从性仍然很低。虽然先前的研究总体上探讨了与实施康复指南相关的障碍，但这些障碍是否特别适用于上肢康复仍不清楚。为了规划有效的实施活动，应确定关键的激励因素和使用障碍。
为了调查职业治疗师和物理治疗师对在中风康复中使用上肢临床实践指南建议的激励因素和障碍的看法，进行了一项混合方法研究。通过在线调查和半结构化焦点小组，邀请了在澳大利亚墨尔本六个中风康复团队之一工作的物理治疗师和职业治疗师参与。调查数据采用描述性统计进行分析，并对自由文本回复进行主题编码。焦点小组进行了转录、主题编码，并根据理论领域框架进行映射。
46名参与者完成了调查，29名参与者参加了焦点小组。使用指南建议的关键激励因素包括过去对特定干预措施的经验、所需资源的可用性以及有利的工作场所文化。障碍包括：特定干预措施的培训/技能有限、干预方案的复杂性以及对干预效果的信念。缺乏问责制被突出强调，治疗师认为他们很少因质量保证目的而被检查是否遵守指南。
治疗师发现，实施最佳实践上肢康复的激励因素和障碍在很大程度上都发生在个人和环境层面。因此，干预措施应聚焦于这两个层面以促进变革。
