Healthcare professionals' perceived barriers and facilitators of implementing clinical practice guidelines for stroke rehabilitation: A systematic review.
Adrienne Cormican, Shashivadan P Hirani, Eamonn McKeown
PMID 36475911WHAT IT FOUND
Time and resources were the most consistent issue in stroke guideline implementation.
Competing tasks, poor protocols and low confidence blocked use. Protected time, local routines, training, audit and champions helped.
Key findings
01Time and resources were reported in all 22 included studies, mainly as barriers and as facilitators when time and resources were available.
02Organisational processes such as organised dissemination, training, local protocols, performance monitoring and reminders were reported as facilitators in 18 studies.
03Guidelines were more likely to be used when recommendations were clear, fitted existing routines and clinicians saw patient benefit; they were resisted when seen as too idealistic or too time intensive.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review reports perceived barriers and facilitators, not patient outcomes or tested effects of implementation strategies. The included studies were heterogeneous, with qualitative, cross-sectional and mixed-method designs. Quality appraisal was used, but study quality was not an inclusion criterion. One author did most data extraction and synthesis, with validation from another author only for five randomly selected studies. Not every available database was searched, and local quality improvement projects may not have been published, so relevant studies could have been missed. Only English studies were included. Quantitative and mixed-method studies sometimes gave thin descriptions of perceived barriers and facilitators. The review could not determine which implementation interventions work better than others.
The easy way to misread this
Do not read this as evidence that protected time, training, audit or champions improve patient recovery. It reports what professionals perceived about guideline use, not the effect of those implementation strategies on stroke outcomes.