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Increasing the uptake of stroke upper limb guideline recommendations with occupational therapists and physiotherapists. A qualitative study using the Theoretical Domains Framework
Author(s) -
Jolliffe Laura,
Hoffmann Tammy,
Lannin Natasha A.
Publication year - 2019
Publication title -
australian occupational therapy journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.595
H-Index - 44
eISSN - 1440-1630
pISSN - 0045-0766
DOI - 10.1111/1440-1630.12599
Subject(s) - rehabilitation , focus group , psychological intervention , thematic analysis , guideline , medicine , occupational therapy , evidence based practice , intervention (counseling) , nursing , qualitative research , physical therapy , psychology , alternative medicine , social science , pathology , marketing , sociology , business
Despite the availability of stroke clinical practice guidelines and acceptance by therapists that guidelines contain ‘best practice’ recommendations, compliance remains low. While previous studies have explored barriers associated with implementing rehabilitation guidelines in general, it remains unknown if these barriers are applicable to upper limb rehabilitation specifically. To plan effective implementation activities, key motivators and barriers to use should be identified. Method To investigate occupational and physiotherapists’ perceptions of motivators and barriers to using upper limb clinical practice guideline recommendations in stroke rehabilitation, a mixed‐method study was conducted. Using an online survey and semi‐structured focus groups, physiotherapists and occupational therapists working in one of six stroke rehabilitation teams in Melbourne, Australia were invited to participate. Survey data were analysed using descriptive statistics, and thematic coding of free‐text responses. Focus groups were transcribed, thematically coded and mapped against the Theoretical Domains Framework. Results Forty‐six participants completed the survey and 29 participated in the focus groups. Key motivators to use guideline recommendations included past experience with specific interventions, availability of required resources and an enabling workplace culture. Barriers included: limited training/skills in specific interventions, the complexity of intervention protocols, and beliefs about intervention effectiveness. Lack of accountability was highlighted and therapists perceived they are rarely checked for quality assurance purposes regarding guideline adherence. Conclusion Therapists identified that both motivators and barriers to implementing best‐practice upper limb rehabilitation occur largely at the levels of the individual and the environment. As such, intervention efforts should focus at both these levels to facilitate change.