Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/25962
Title: Early Mobilization After Stroke: Do Clinical Practice Guidelines Support Clinicians' Decision-Making?
Austin Authors: Rethnam, Venesha;Hayward, Kathryn S ;Bernhardt, Julie;Churilov, Leonid 
Affiliation: Melbourne School of Health Sciences, University of Melbourne, Parkville, VIC, Australia
Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
The Florey Institute of Neuroscience and Mental Health
National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, VIC, Australia
Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
Issue Date: 5-Feb-2021
Date: 2021-02-05
Publication information: Frontiers in Neurology 2021; 12: 606525
Abstract: Importance: Early mobilization, out-of-bed activity, is a component of acute stroke unit care; however, stroke patient heterogeneity requires complex decision-making. Clinically credible and applicable CPGs are needed to support and optimize the delivery of care. In this study, we are specifically exploring the role of clinical practice guidelines to support individual patient-level decision-making by stroke clinicians about early mobilization post-stroke. Methods: Our study uses a novel, two-pronged approach. (1) A review of CPGs containing recommendations for early mobilization practices published after 2015 was appraised using purposely selected items from the Appraisal of Guidelines Research and Evaluation-Recommendations Excellence (AGREE-REX) tool relevant to decision-making for clinicians. (2) A cross-sectional study involving semi-structured interviews with Australian expert stroke clinicians representing content experts and CPG target users. Every CPG was independently assessed against the AGREE-REX standard by two reviewers. Expert stroke clinicians, invited via email, were recruited between June 2019 to March 2020.The main outcomes from the review was the proportion of criteria addressed for each AGREE-REX item by individual and all CPG(s). The main cross-sectional outcomes were the distributions of stroke clinicians' responses about the utility of CPGs, specific areas of uncertainty in early mobilization decision-making, and suggested parameters for inclusion in future early mobilization CPGs. Results: In 18 identified CPGs, many did not adequately address the "Evidence" and "Applicability to Patients" AGREE-REX items. Out of 30 expert stroke clinicians (11 physicians [37%], 11 physiotherapists [37%], 8 nurses [26%]; median [IQR] years of experience, 14 [10-25]), 47% found current CPGs "too broad or vague," while 40% rely on individual clinical judgement and interpretation of the evidence to select an evidence-based choice of action. The areas of uncertainty in decision-making revealed four key suggestions: (1) more granular descriptions of patient and stroke characteristics for appropriate tailoring of decisions, (2) clear statements about when clinical flexibility is appropriate, (3) detailed description of the intervention dose, and (4) physical assessment criteria including safety parameters. Conclusions: The lack of specificity, clinical applicability, and adaptability of current CPGs to effectively respond to the heterogeneous clinical stroke context has provided a clear direction for improvement.
URI: https://ahro.austin.org.au/austinjspui/handle/1/25962
DOI: 10.3389/fneur.2021.606525
Journal: Frontiers in Neurology
PubMed URL: 33633667
ISSN: 1664-2295
Type: Journal Article
Subjects: AGREE-REX
acute Stroke the limitations of early mobilization clinical practice guidelines
agree
clinical practice guidelines
early mobilization
Stroke
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