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    Synthesising practice guidelines for the development of community-based exercise programmes after stroke

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    Author
    Poltawski, L; Abraham, C; Forster, A; Goodwin, VA; Kilbride, C; Taylor, RS; Dean, S
    Date
    2013-10-01
    Source Title
    Implementation Science
    Publisher
    BMC
    University of Melbourne Author/s
    Abraham, Samuel
    Affiliation
    Melbourne School of Psychological Sciences
    Metadata
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    Document Type
    Journal Article
    Citations
    Poltawski, L., Abraham, C., Forster, A., Goodwin, V. A., Kilbride, C., Taylor, R. S. & Dean, S. (2013). Synthesising practice guidelines for the development of community-based exercise programmes after stroke. IMPLEMENTATION SCIENCE, 8 (1), https://doi.org/10.1186/1748-5908-8-115.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/253094
    DOI
    10.1186/1748-5908-8-115
    Abstract
    BACKGROUND: Multiple guidelines are often available to inform practice in complex interventions. Guidance implementation may be facilitated if it is tailored to particular clinical issues and contexts. It should also aim to specify all elements of interventions that may mediate and modify effectiveness, including both their content and delivery. We conducted a focused synthesis of recommendations from stroke practice guidelines to produce a structured and comprehensive account to facilitate the development of community-based exercise programmes after stroke. METHODS: Published stroke clinical practice guidelines were searched for recommendations relevant to the content and delivery of community-based exercise interventions after stroke. These were synthesised using a framework based on target intervention outcomes, personal and programme proximal objectives, and recommended strategies. RESULTS: Nineteen guidelines were included in the synthesis (STRIDES; STroke Rehabilitation Intervention-Development Evidence Synthesis). Eight target outcomes, 14 proximal objectives, and 94 recommended strategies were identified. The synthesis was structured to present best practice recommendations in a format that could be used by intervention programme developers. It addresses both programme content and context, including personal factors, service standards and delivery issues. Some recommendations relating to content, and many relating to delivery and other contextual issues, were based on low level evidence or expert opinion. Where opinion varied, the synthesis indicates the range of best practice options suggested in guidelines. CONCLUSIONS: The synthesis may assist implementation of best practice by providing a structured intervention description that focuses on a particular clinical application, addresses practical issues involved in programme development and provision, and illustrates the range of best-practice options available to users where robust evidence is lacking. The synthesis approach could be applied to other areas of stroke rehabilitation or to other complex interventions.

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