The impact of stroke practice guidelines on knowledge and practice patterns of acute care health professionals

The Agency for Healthcare Research and Quality's Post-Stroke Rehabilitation Guidelines were developed to improve the quality, appropriateness and effectiveness of rehabilitation practices. An important goal of the guidelines process is to disseminate information to practitioners in order to encourage adoption of effective practices. To date, no systematic evaluation of these guidelines has been completed, nor has a programme been designed to evaluate the effectiveness of an educational programme about the guidelines. The objective was to evaluate changes in knowledge and practice following presentation of a lecture-based, educational programme about post-stroke rehabilitation guidelines.

The research design was a single group, pre-test-post-test design without a comparison group. A knowledge and referral practices questionnaire was developed specifically for this study.

Lecture attendance was not associated with an increase in knowledge or referrals. However, we found that respondents who made more referrals at follow-up had a higher knowledge level at pre-test. Also, those who completed a follow-up assessment knew more about the guidelines at the initial assessment than did those who did not complete the follow-up assessment. In addition, doctors knew more about stroke rehabilitation than the non-doctors, both at the pre-test and follow-up.

Encouraging behaviour change among doctors and allied health professionals in referrals and clinical practice is a complicated process. Providing individual follow-up and lengthier contacts, assuring that care providers receive high-quality evidence that guidelines improve care, and consulting with key decision-makers about guideline implementation might enhance behaviour change.