Barriers to evidence-based rehabilitation

March Journal Club: Bayley et al (2012) Barriers to implementation of stroke rehabilitation evidence: findings from a multi-site pilot project. Disability and Rehabilitation 34(19):1633-8. doi: 10.3109/09638288.2012.65679

Purpose: To describe the barriers to implementation of evidence-based 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.

Implications for Rehabilitation

* Despite increasingly strong evidence for stroke rehabilitation, there are delays in implementation into clinical practice.

* This study showed that lack of time, staffing issues, staff education, therapy selection or prioritization, lack of equipment and team functioning were the main barriers to implementation.

* Managers and stakeholders should consider these barriers and prioritize evidence when implementing.