Introduction: The Stroke Foundation living guidelines enable rapid access to current evidence-based practice, but there is a lack of practical information on their implementation in health services. This study aimed to investigate current practice in the management of the neurologically impaired upper limb and the barriers and facilitators from an occupational therapist and physiotherapist perspective to implementing best practice at a metropolitan tertiary hospital.
Methods: A mixed-methods approach including a documentation audit of electronic medical records (EMR) and a clinician survey underpinned by the Theoretical Domains Framework (TDF).
Results: Eighty medical records of patients with neurologically impaired upper limbs were audited (60% stroke; 99% both occupational therapy and physiotherapy involvement). There were inconsistent practices for upper limb management across the continuum of care, and limited documented evidence of guideline use (8%). The survey (n=25) found that whilst clinicians were aware of guidelines, barriers exist to implementation mainly under the TDF domains: environmental context and resources, knowledge and skills. Clinicians reported a lack of orientation and training opportunities, inadequate resources, low confidence and lack of recognition for good practice. There were several opportunities to facilitate best practice including optimising EMR, improving orientation and resources, regular auditing and recognition of staff achievement.
Conclusion: Despite best practice, there was limited documented use of guidelines in neurologically impaired upper limb management. Using the TDF, gaps in practice, and strategic direction on how they may be addressed were identified.
Relevance to clinical practice or patient experience: Upper limb impairments are common after stroke and patients are at risk of preventable issues. Whilst best practice guidelines exist for upper limb management, implementation continues to be a practice challenge. Clinicians require adequate training and resources and need to be recognised for their achievements.