College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.
Adelaide Nursing School, University of Adelaide, Adelaide, Australia.
Disabil Rehabil. 2022 Jul;44(15):4118-4125. doi: 10.1080/09638288.2021.1891304. Epub 2021 Mar 2.
To identify health professionals awareness of stroke rehabilitation guidelines, and factors perceived to influence guideline use internationally.
Online survey study. Open-ended responses were thematically analysed, guided by the Consolidated Framework for Implementation Research.
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.
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.IMPLICATIONS FOR REHABILITATIONSystems 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.
确定卫生专业人员对中风康复指南的认识，以及国际上认为影响指南使用的因素。
在线调查研究。根据实施研究综合框架，对开放性回答进行主题分析。
共纳入来自 30 个国家的 833 名受访者的数据。样本中来自 22 个国家的当地制定的指南已经可用。与来自中低收入国家的受访者相比，高收入国家的受访者对当地指南的认识程度更高。管理支持和重视循证实践的文化等当地背景因素被报告为积极影响指南使用，而时间不足和熟练人员短缺则抑制了推荐护理的实施。据报道，改善指南使用的流程包括教育、培训、工作组的组建以及审计反馈循环。更广泛的背景因素包括卫生专业人员是否有责任根据指南建议提供康复服务。
尽管许多卫生专业人员都了解临床指南，但他们也指出了实施指南的多个障碍。应努力提高中低收入国家对当地指南的认识。应更加关注解决当地背景因素，以提高国际上的指南使用，超越以个体卫生专业人员为重点的传统策略。
需要建立系统，使个人和组织有责任提供中风康复方面的循证护理。应推广当地制定的中风康复指南，以提高中低收入国家对这些指南的认识。在所有地区，都需要采取策略来影响或适应当地环境，以优化指南的使用。
