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

Poltawski, L., Abraham, C., Forster, A., Goodwin, V. A., Kilbride, C., Taylor, R. S. and Dean, S. (2013) Synthesising practice guidelines for the development of community-based exercise programmes after stroke. Implementation Science, 8(1), 115. (doi: 10.1186/1748-5908-8-115)

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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; ST roke R ehabilitation I ntervention-D evelopment E vidence S ynthesis). 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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Taylor, Professor Rod
Authors: Poltawski, L., Abraham, C., Forster, A., Goodwin, V. A., Kilbride, C., Taylor, R. S., and Dean, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:Implementation Science
Publisher:BMC
ISSN:1748-5908
ISSN (Online):1748-5908
Copyright Holders:Copyright © 2013 Poltawski et al.
First Published:First published in Implementation Science 8(1):115
Publisher Policy:Reproduced under a Creative Commons license

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