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From theory to practice: a conceptual framework to facilitate implementation of evidence in stroke rehabilitation for local context in Saudi Arabia

Authors Alatawi SF

Received 15 April 2019

Accepted for publication 27 May 2019

Published 5 July 2019 Volume 2019:12 Pages 515—525

DOI https://doi.org/10.2147/JMDH.S212372

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser


Salem F Alatawi

Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk City, Kingdom of Saudi Arabia

Introduction: Implementing evidence into practice is a global priority with implications for patients, researchers, practitioners and policy-makers (stakeholders). The national clinical guideline (NCG) for stroke is one of the most important sources of robust evidence. However, implementation within real practice is often slow to respond. The knowledge to action (KTA) framework is one of several frameworks to facilitate implementation and enable evidence to be put into operation. This study aims to develop a conceptual framework to understand the process of implementation of an NCG for stroke in the local context of physiotherapy practice in the Kingdom of Saudi Arabia.
Methods: A qualitative–quantitative mixed methods study was conducted. The first method (panel meetings, 10 expert physiotherapists) was to chart the main concepts/domains of physiotherapy practice in the UK NCG for stroke. Drawing on panel meeting findings, 75 recommendations were released as an online questionnaire to 35 Saudi stroke specialist physiotherapists. This was followed by a focus group (second method) to capture the process of implementation of NCG for stroke in the Kingdom of Saudi Arabia.
Results: Sixty-one recommendations were accepted to be applied in real practice, whereas only 14 recommendations were rejected. The paper presents the first empirically derived framework that establishes thecontributionof physiotherapy to stroke rehabilitation. This framework characterizes the real-world nature of the implementation of NCGs for stroke within physiotherapy practice. This framework reaffirms the importance of supportive organizational culture, the specific need of end users, patient factors, and finally transferability of the evidence.
Discussion: This conceptual framework appears to provide a reasonable approach for the development of implementation strategies for physiotherapist practice in stroke rehabilitation. Furthermore, it might be the first that reflects the real value of the KTA framework and tests it empirically.
Conclusion: The finding of this study provides a useful comprehensive framework to implement existing NCGs for stroke.

Keywords: physiotherapists/physical therapists practice, stroke rehabilitation, knowledge translation, national clinical guidelines, implementation


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