Do clinical guidelines guide clinical practice in stroke rehabilitation? An international survey of health professionals.
Authors: Lynch, Elizabeth A.; Connell, Louise A.; Carvalho, Lilian B.; Bird, Marie-Louise
Source: Disability & Rehabilitation (DISABIL REHABIL), Jul2022; 44(15): 4118-4125. (8p)
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. Systems 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.
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Authors: Hamer, Oliver; Lowther, Hayley; Harrison, Helen; Hill, James
Source: British Journal of Neuroscience Nursing (BR J NEUROSCI NURS), Jun2022; 18(3): 142-145. (4p)
Stroke remains one of the leading causes of death worldwide. To tackle the negative impacts of stroke, a high standard of clinical practice and a commitment to continuous quality improvement is needed across the stroke care pathway. One approach to quality improvement is the formation and implementation of quality improvement collaboratives. However, there are several barriers to the implementation of a quality improvement collaborative for stroke care which may impact on its success. This article critically appraises a systematic review that assessed the effectiveness of quality improvement collaboratives for driving improvements in stroke care and explored the barriers to implementing a quality improvement collaborative to improve care.
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Author(s) Cadilhac ; Bagot, Kathleen L; Demaerschalk, Bart M; Hubert, Gordian; Schwamm, Lee et al.
Source Journal of Telemedicine & Telecare; Oct 2021; vol. 27 (no. 9); p. 582-589
Publication Date Oct 2021
Introduction: Globally, the use of telestroke programmes for acute care is expanding. Currently, a standardised set of variables for enabling reliable international comparisons of telestroke programmes does not exist. The aim of the study was to establish a consensus-based, minimum dataset for acute telestroke to enable the reliable comparison of programmes, clinical management and patient outcomes.Methods: An initial scoping review of variables was conducted, supplemented by reaching out to colleagues leading some of these programmes in different countries. An international expert panel of clinicians, researchers and managers (n = 20) from the Australasia Pacific region, USA, UK and Europe was convened. A modified-Delphi technique was used to achieve consensus via online questionnaires, teleconferences and email.Results: Overall, 533 variables were initially identified and harmonised into 159 variables for the expert panel to review. The final dataset included 110 variables covering three themes (service configuration, consultations, patient information) and 12 categories: (1) details about telestroke network/programme (n = 12), (2) details about initiating hospital (n = 10), (3) telestroke consultation (n = 17), (4) patient characteristics (n = 7), (5) presentation to hospital (n = 5), (6) general clinical care within first 24 hours (n = 10), (7) thrombolysis treatment (n = 10), (8) endovascular treatment (n = 13), (9) neurosurgery treatment (n = 8), (10) processes of care beyond 24 hours (n = 7), (11) discharge information (n = 5), (12) post-discharge and follow-up data (n = 6).Discussion: The acute telestroke minimum dataset provides a recommended set of variables to systematically evaluate acute telestroke programmes in different countries. Adoption is recommended for new and existing services.
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