Purpose: To describe the barriers to implementation of evidencebased
recommendations (EBRs) for stroke rehabilitation
experienced by nurses, occupational therapists, physical therapists,
physicians and hospital managers. Methods: The Stroke Canada
Optimization of Rehabilitation by Evidence project developed
EBRs for arm and leg rehabilitation after stroke. Five Canadian
stroke inpatient rehabilitation centers participated in a pilot
implementation study. At each site, a clinician was identified as
the “local facilitator” to promote the 6-month implementation.
A research coordinator observed the process. Focus groups
done at completion were analyzed thematically for barriers by
two raters. Results: A total of 79 rehabilitation professionals (23
occupational therapists, 17 physical therapists, 23 nurses and
16 directors/managers) participated in 21 focus groups of three
to six participants each. The most commonly noted barrier to
implementation was lack of time followed by staffing issues,
training/education, therapy selection and prioritization, equipment
availability and team functioning/communication. There was
variation in perceptions of barriers across stakeholders. Nurses
noted more training and staffing issues and managers perceived
fewer barriers than frontline clinicians. Conclusions: Rehabilitation
guideline developers should prioritize evidence for implementation
and employ user-friendly language. Guideline implementation
strategies must be extremely time efficient. Organizational
approaches may be required to overcome the barriers.
Purpose: To describe the barriers to implementation of evidencebasedrecommendations (EBRs) for stroke rehabilitationexperienced by nurses, occupational therapists, physical therapists,physicians and hospital managers. Methods: The Stroke CanadaOptimization of Rehabilitation by Evidence project developedEBRs for arm and leg rehabilitation after stroke. Five Canadianstroke inpatient rehabilitation centers participated in a pilotimplementation study. At each site, a clinician was identified asthe “local facilitator” to promote the 6-month implementation.A research coordinator observed the process. Focus groupsdone at completion were analyzed thematically for barriers bytwo raters. Results: A total of 79 rehabilitation professionals (23occupational therapists, 17 physical therapists, 23 nurses and16 directors/managers) participated in 21 focus groups of threeto six participants each. The most commonly noted barrier toimplementation was lack of time followed by staffing issues,training/education, therapy selection and prioritization, equipmentavailability and team functioning/communication. There wasvariation in perceptions of barriers across stakeholders. Nursesnoted more training and staffing issues and managers perceivedfewer barriers than frontline clinicians. Conclusions: Rehabilitationguideline developers should prioritize evidence for implementationand employ user-friendly language. Guideline implementationstrategies must be extremely time efficient. Organizationalapproaches may be required to overcome the barriers.
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