How Do Therapists Understand and Intend to Implement Practice Guideline Recommendations for Rehabilitation of the Upper Limb Following Stroke
Bibliographic record
Abstract
Stroke rehabilitation interventions must be evidence-based and applicable to a range of stroke subtypes and severity of disabilities to obtain the optimal outcomes. Clinical practice guidelines assist clinicians to implement rehabilitation plans based on research evidence. Evaluations of clinicians’ practices suggest that therapists may not be following guidelines, which may explain why patient outcomes are less than expected. To increase therapists' adherence to guidelines, it would help to understand their understanding, barriers and facilitators to implementing a clinical guideline. The purpose of this thesis was to demonstrate how rehabilitation therapists understand and interpret specific clinical guideline recommendations for upper limb rehabilitation post-stroke, and to identify perceived implementation barriers and facilitators. This thesis has two elements. The first demonstrates the application of the Theory of Planned Behaviour as a conceptual framework for understanding rehabilitation professionals’ intention toward implementation of clinical guidelines in rehabilitation of persons following stroke. The second part illustrates how physiotherapists and occupational therapists understand the individual recommendations for rehabilitation of upper extremity after stroke from the Canadian Best Practice Recommendations for Stroke Care. It also characterizes the barriers and facilitators that influence therapists’ uptake of these recommendations. The data for second manuscript were collected from therapists in two different countries (Canada and Saudi Arabia) to explore the global issues of clinical guidelines implementation. The review of the Theory of Planned Behaviour informed the study design and thinking about barriers and facilitators; but thematic analyses were driven by the data, not by theory. The similarities across health systems in the two countries were more striking than the differences, highlighting common challenges for guideline implementation. The findings of this thesis highlight the need for clearer communication of the specific actions intended by the CPG, and education of therapists to ensure they know how to implement interventions utilizing these specific actions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.065 | 0.299 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.005 |
| Scholarly communication | 0.012 | 0.016 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.006 | 0.006 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".