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Open Access Highly Accessed Research article

Speech pathologists’ experiences with stroke clinical practice guidelines and the barriers and facilitators influencing their use: a national descriptive study

Kathleen A Hadely1, Emma Power12* and Robyn O’Halloran23

Author Affiliations

1 Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe NSW 2141, Australia

2 Centre for Clinical Research Excellence in Aphasia Rehabilitation, Brisbane, Australia

3 Department of Human Communication Sciences, La Trobe University, PO Box 199, Bendigo VIC 3552, Australia

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BMC Health Services Research 2014, 14:110  doi:10.1186/1472-6963-14-110

Published: 6 March 2014

Abstract

Background

Communication and swallowing disorders are a common consequence of stroke. Clinical practice guidelines (CPGs) have been created to assist health professionals to put research evidence into clinical practice and can improve stroke care outcomes. However, CPGs are often not successfully implemented in clinical practice and research is needed to explore the factors that influence speech pathologists’ implementation of stroke CPGs. This study aimed to describe speech pathologists’ experiences and current use of guidelines, and to identify what factors influence speech pathologists’ implementation of stroke CPGs.

Methods

Speech pathologists working in stroke rehabilitation who had used a stroke CPG were invited to complete a 39-item online survey. Content analysis and descriptive and inferential statistics were used to analyse the data.

Results

320 participants from all states and territories of Australia were surveyed. Almost all speech pathologists had used a stroke CPG and had found the guideline “somewhat useful” or “very useful”. Factors that speech pathologists perceived influenced CPG implementation included the: (a) guideline itself, (b) work environment, (c) aspects related to the speech pathologist themselves, (d) patient characteristics, and (e) types of implementation strategies provided.

Conclusions

There are many different factors that can influence speech pathologists’ implementation of CPGs. The factors that influenced the implementation of CPGs can be understood in terms of knowledge creation and implementation frameworks. Speech pathologists should continue to adapt the stroke CPG to their local work environment and evaluate their use. To enhance guideline implementation, they may benefit from a combination of educational meetings and resources, outreach visits, support from senior colleagues, and audit and feedback strategies.

Keywords:
Speech pathologist; Stroke; Rehabilitation; Clinical practice guideline; Knowledge translation; Knowledge to action framework; Barriers; Facilitators; Implementation