A South African experience in applying the Adopt\u2013Contextualise\u2013Adapt framework to stroke rehabilitation clinical practice guidelines

Karen Grimmer,Charles S Wiysonge,Janine M Dizon,Dawn Ernstzen,Sjan-Mari Brown,Quinette Louw

doi:10.1186/s12961-019-0454-x

Abstract

BackgroundClinical practice guideline (CPG) activity has escalated internationally in the last 20 years, leading to increasingly sophisticated methods for CPG developers and implementers. Despite this, there remains a lack of practical support for end-users in terms of effectively and efficiently implementing CPG recommendations into local practice. This paper describes South African experiences in implementing international CPG recommendations for best practice stroke rehabilitation into local contexts, using a purpose-build approach.MethodsComposite recommendations were synthesised from 16 international CPGs to address end-user questions about best practice rehabilitation for South African stroke survivors. End-user representatives on the project team included methodologists, policy-makers, clinicians, managers, educators, researchers and stroke survivors. The Adopt–Contextualise–Adapt model was applied as a decision-guide to streamline discussions on endorsement and development of implementation strategies. Where recommendations required contextualisation to address local barriers before they could be effectively implemented, prompts were provided to identify barriers and possible solutions. Where recommendations could not be implemented without additional local evidence (adaptation), options were identified to establish new evidence.FindingsThe structured implementation process was efficient in terms of time, effort, resources and problem solving. The process empowered the project team to make practical decisions about local uptake of international recommendations, develop local implementation strategies, and determine who was responsible, for what and when. Different implementation strategies for the same recommendation were identified for different settings, to address different barriers.ConclusionThe South African evidence translation experience could be useful for evidence implementers in other countries, when translating CPG recommendations developed elsewhere, into local practice.

Highlights

Clinical practice guideline (CPG) activity has escalated internationally in the last 20 years, leading to increasingly sophisticated methods for clinical practice guidelines (CPGs) developers and implementers
The South African evidence translation experience could be useful for evidence implementers in other countries, when translating CPG recommendations developed elsewhere, into local practice
Firstly to synthesise recommendations extracted from the international CPGs that were relevant to South African stroke rehabilitation questions, and secondly to describe the composite evidence base underpinning each synthesised recommendation [5]

Summary

Introduction

Clinical practice guideline (CPG) activity has escalated internationally in the last 20 years, leading to increasingly sophisticated methods for CPG developers and implementers. This paper describes South African experiences in implementing international CPG recommendations for best practice stroke rehabilitation into local contexts, using a purpose-build approach. Our recent search for freely available CPGs for stroke rehabilitation, published from 2010 onwards, identified 16 CPGs of mostly moderate-to-good methodological quality, from the United Kingdom (n = 2), United States of America (n = 5), Australia (n = 5) and one each from Canada, Malaysia, New Zealand and South Africa [5]. The South African stroke CPG was 7 years old, dealing mostly with medical stroke care and providing few rehabilitation recommendations

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Conclusion