Assessing and Addressing the Perceived Barriers to Evidence-Based Stroke Rehabilitation

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Year
Authors
Pollock A, Legg L, Langhorne P, Sellars C
Abstract
Introduction:

Objectives: The Stroke Therapy Evaluation Programme (STEP) has the broad objective of encouraging the implementation of evidence-based stroke rehabilitation. The aim of this study was to determine the perceived barriers to evidence-based stroke rehabilitation among health-care practitioners, in order to identify strategies aimed at removing these barriers.

Methods: The first phase of the study involved inviting health professionals working in stroke rehabilitation throughout Scotland to attend a workshop. After initial presentations on evidence-based practice, the workshop participants (n=105) worked in small focus groups to identify and discuss perceived barriers to evidence-based stroke rehabilitation. The information from these groups was used to generate statements that were incorporated within a questionnaire. Following piloting, the questionnaire was sent to the original workshop participants who recorded their level of agreement (on a sliding scale from 1 to 5) with each of the stated barriers

Results: 86 (82%) of the questionnaires were completed and returned. Twenty different barriers to the implementation of evidence-based stroke rehabilitation were identified during the workshop, which fell into 3 broad categories: training, opportunity and implementation. The majority of respondents (91%) said that keeping up-to-date with stroke-related literature / research was important to them; however, 77% indicated that they were unhappy with the time that they had available to do this. Furthermore, 67% of respondents indicated that they required further training in the critical appraisal of stroke-related literature. Only 4% found it easy to transfer research findings into practice: 38% perceived the majority of research to be relevant, while 57% said that there was a definite divide between research and the practicalities of clinical practice. Variations between the responses of different professional disciplines were explored.

Discussion: Fundamental barriers to the implementation of evidence-based stroke rehabilitation include difficulties in accessing research reports (lack of time and resources), in appraising research reports (lack of ability) and a lack of relevant published research. STEP has initiated a number of strategies aimed at addressing these barriers, including the. dissemination of recent research findings and training in critical appraisal. The perceived benefits of these strategies are now being assessed on an on-going basis and preliminary progress will be discussed.