Implementation of recommendations from the Philippine Academy of Rehabilitation Medicine's Stroke Rehabilitation Guideline: a plan of action

Consuelo B Gonzalez-Suarez,^1–3 Janine Margarita R Dizon,³ Karen Grimmer,⁴ Myrna S Estrada,^2,5 Edgardo D Uyehara,^2,6 Lauren Anne S Liao,^1,2 Anne-Rochelle D Malleta,^2,7 Ma Elena R Tan,^2,6 Vero Marfil,⁶ Cristina Sanchez-Versales,¹ Jimah L Suarez,^2,7 Kleon C So,¹ Philip John B Fabia,¹ Jose Bonifacio S Rafanan,^2,8 Romil M Martinez<sup>2,9

1</sup>University of Santo Tomas Hospital, Manila, Philippines; ²Philippine Academy of Rehabilitation Medicine, Quezon City, Philippines; ³University of Santo Tomas, Manila, Philippines; ⁴International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia; ⁵Dela Salle University Hospital, Cavite, Philippines; ⁶Veterans' Memorial Medical Center, Quezon City, Philippines; ⁷Philippine Orthopedic Center, Quezon City, Philippines; ⁸Philippine General Hospital, Manila, Philippines; ⁹Amang Rodriguez Memorial Medical Center, Rizal, Philippines

Background: Based on the best current evidence, stroke rehabilitation significantly improves health outcomes. The Philippine Academy of Rehabilitation Medicine (PARM) recently developed Filipino contextualized guidelines for stroke rehabilitation. This paper presents a protocol for the implementation phase of the Stroke Rehabilitation Guideline.
Methods: A multidisciplinary working group comprising medical and paramedical personnel engaged in stroke rehabilitation in four Filipino training hospitals attended a 2-day workshop to develop an implementation plan for six high-evidenced recommendations for inpatient rehabilitation. Recommendations were for early referral for rehabilitation, increasing intensity of exercise, dysphagia assessment, pressure sore assessment and treatment, and a planned rehabilitation discharge summary.
Results: A three-step protocol was developed for guideline implementation: (1) designing an audit protocol to describe current stroke care practice; (2) identifying the most appropriate methods for effectively disseminating the guideline; and (3) considering the best approaches to change professional behaviors relating to the implementation strategies, including these local Filipino professional training, practice and service provision models. Clinical protocols were developed to support standard application of the recommendations.
Conclusion: It is anticipated that by applying effective guideline dissemination strategies adapted for local contexts and addressing specific stakeholder learning and behavior change requirements, the potential for sustained uptake of the guidelines will be achieved. This will result in less stakeholder resistance to evidence-based practices, better processes and health outcomes, fewer adverse events, and more effective resource utilization.

Keywords: stroke rehabilitation, evidence-based practice, clinical practice guidelines, implementation, behavior change