The Tailoring Of National Guidelines For Upper Extremity Post-Stroke Rehabilitation: A Concept In Use.

Abstract

Background: In Saudi Arabia, national evidence-based clinical guidelines (NCG) were created based for healthcare interventions. However, clinicians appear to be slow to incorporate the evidence into practice. As a result, there exists a time-gap between the gathering and presentation of evidence for best practice and the use of that evidence by clinicians. It becomes, therefore, imperative to investigate the gap between the research evidence and clinical practice. The knowledge to action (KTA) framework is available to facilitate the implementation of research evidence. This framework incorporates the theory of tailoring, a concept that is intended to create a fit between the evidence for the intervention and its use by the clinician. Unfortunately, the process of tailoring stills awaits clear guidelines on how it should be implemented. Consequently, this study presents hitherto unknown strategies for using novel methods, which reflect the particular role of the KTA framework in tailoring recommendations. Aim: The purpose of this study is to examine the use of the UK National Clinical Guidelines for Stroke as a clinical tool for tailoring evidence around upper extremity (UE) rehabilitation after a stroke. Methods: This study used a mixed methods (consensus approach), which includes a survey (n = 26) and nominal group meeting (NGM) with physiotherapists (n=15). Result: The first part of this study (survey) showed that 59 items (recommendations) from the UK National Clinical Guidelines for Stroke around UE post-stroke rehabilitation were accepted as consensus. Of these fifty-nine items, only 5 were rated as “no consensus.” In addition, of all the items that had been included, not a single one was rejected. The results led to three groups of recommendations based on the agreed median scores. These are as follow: lack of agreement (no consensus), highest consensus with tightest range of scores, or lowest consensus with widest range of scores. The second part of this study (NGM) explores four themes, which appeared to significantly influence the concept of “tailoring” and the participants’ ways of thinking. Conclusion: This study illustrates the role of tailoring in bridging the time-gap between the evidence and its implementation in the clinical setting. The study also provides more clarification about the role of tailoring and outlines the steps required to effectively investigate it.