Barriers to implementation of stroke rehabilitation evidence: findings from a multi-site pilot project

Disabil Rehabil. 2012;34(19):1633-8. doi: 10.3109/09638288.2012.656790. Epub 2012 May 28.


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. [Box: see text].

MeSH terms

  • Attitude of Health Personnel*
  • Canada
  • Communication
  • Education, Continuing
  • Evidence-Based Medicine*
  • Focus Groups
  • Health Knowledge, Attitudes, Practice*
  • Health Personnel / education*
  • Humans
  • Pilot Projects
  • Professional Competence
  • Qualitative Research
  • Rehabilitation Centers / organization & administration
  • Stroke Rehabilitation*
  • Translational Research, Biomedical