What influences the implementation of the New Zealand stroke guidelines for physiotherapists and occupational therapists?

Purpose: To explore perceived barriers and facilitators to the use of the NZ Stroke Guidelines by occupational therapists and physiotherapists. Method: A qualitative descriptive methodology was used. Eligible physiotherapists and occupational therapists (NZ registered, working in one of two hospitals, treating at least 10 patients with stroke in the previous year) were invited to participate in semi-structured interviews to elicit their perceptions of the utility and feasibility of the NZ stroke guidelines and identify barriers and facilitators to their implementation. All interviews were audio-recorded and transcribed. Conventional content analysis with constant comparative methods was used for coding and analysis. Results: The main themes influencing guideline implementation were resources and characteristics of the guidelines, the organisation, the patient and family and the therapist. Insufficient resources were a major barrier that crossed many of the themes. Participants suggested a range of strategies relating to the organisation to improve therapists’ alignment to the guidelines. Conclusion: Alignment to the guidelines in New Zealand is influenced both positively and negatively by a range of interacting factors, consistent with other studies. Alignment might be improved by the introduction of some relatively simple strategies, such as ring-fencing time for access to resources and training in the use of the guidelines. Many of the barriers and related interventions are likely to be more complex.