Alatawi Salem F
Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk City, Kingdom of Saudi Arabia.
J Multidiscip Healthc. 2019 Jul 5;12:515-525. doi: 10.2147/JMDH.S212372. eCollection 2019.
Implementing evidence into practice is a global priority with implications for patients, researchers, practitioners and policy-makers (stakeholders). The national clinical guideline (NCG) for stroke is one of the most important sources of robust evidence. However, implementation within real practice is often slow to respond. The knowledge to action (KTA) framework is one of several frameworks to facilitate implementation and enable evidence to be put into operation. This study aims to develop a conceptual framework to understand the process of implementation of an NCG for stroke in the local context of physiotherapy practice in the Kingdom of Saudi Arabia.
A qualitative-quantitative mixed methods study was conducted. The first method (panel meetings, 10 expert physiotherapists) was to chart the main concepts/domains of physiotherapy practice in the UK NCG for stroke. Drawing on panel meeting findings, 75 recommendations were released as an online questionnaire to 35 Saudi stroke specialist physiotherapists. This was followed by a focus group (second method) to capture the process of implementation of NCG for stroke in the Kingdom of Saudi Arabia.
Sixty-one recommendations were accepted to be applied in real practice, whereas only 14 recommendations were rejected. The paper presents the first empirically derived framework that establishes the contribution of physiotherapy to stroke rehabilitation. This framework characterizes the real-world nature of the implementation of NCGs for stroke within physiotherapy practice. This framework reaffirms the importance of supportive organizational culture, the specific need of end users, patient factors, and finally transferability of the evidence.
This conceptual framework appears to provide a reasonable approach for the development of implementation strategies for physiotherapist practice in stroke rehabilitation. Furthermore, it might be the first that reflects the real value of the KTA framework and tests it empirically.
The finding of this study provides a useful comprehensive framework to implement existing NCGs for stroke.
将证据应用于实践是一项全球优先事项，对患者、研究人员、从业者和政策制定者（利益相关者）都有影响。国家中风临床指南（NCG）是有力证据的最重要来源之一。然而，在实际实践中的实施往往反应迟缓。知识转化为行动（KTA）框架是促进实施并使证据得以付诸实践的几个框架之一。本研究旨在构建一个概念框架，以了解在沙特阿拉伯王国物理治疗实践的本地背景下实施中风NCG的过程。
进行了定性 - 定量混合方法研究。第一种方法（小组会议，10名物理治疗专家）是梳理英国中风NCG中物理治疗实践的主要概念/领域。根据小组会议结果，向35名沙特中风专科物理治疗师发布了一份包含75条建议的在线问卷。随后进行了焦点小组讨论（第二种方法），以了解沙特阿拉伯王国中风NCG的实施过程。
61条建议被接受用于实际实践，而只有14条建议被拒绝。本文提出了首个基于实证得出的框架，该框架确定了物理治疗对中风康复的贡献。此框架描述了物理治疗实践中中风NCG实施的现实情况。该框架重申了支持性组织文化的重要性、终端用户的特殊需求、患者因素以及最终证据的可转移性。
这个概念框架似乎为制定中风康复中物理治疗师实践的实施策略提供了一种合理方法。此外，它可能是首个反映KTA框架实际价值并对其进行实证检验的框架。
本研究结果为实施现有的中风NCG提供了一个有用的综合框架。
