# Using Implementation Theories to Tailor International Clinical Guidelines for Post-Stroke Gait Disorders

## TL;DR

This study explores how to adapt international stroke guidelines for gait disorders by considering factors like organizational settings, clinician expertise, and patient needs.

## Contribution

The study introduces a systematic approach using implementation theories to tailor stroke rehabilitation guidelines for gait disorders.

## Key findings

- 21 recommendations reached consensus in phase one, with 14 rated highly applicable by physiotherapists.
- Four key themes influencing tailoring were identified: organizational factors, clinician factors, patient factors, and research design.
- No recommendations were rejected, and all were considered feasible with some adjustments.

## Abstract

Background/objective: Tailoring involves adapting research findings and evidence to suit specific contexts and audiences. This study examines how international stroke guidelines can be tailored to address gait issues after a stroke. Methods: A three-phase consensus method approach was used. A 10-member health experts panel extracted recommendations from three national clinical guidelines in the first phase. In the second phase, 362 physiotherapists completed an online questionnaire to assess the feasibility of adopting the extracted recommendations. In the third phase, a 15-physical therapist consensus workshop was convened to clarify factors that might affect the tailoring process of the extracted recommendations of gait disorder rehabilitation. Results: In phase one, 21 recommendations reached consensus. In the second phase, 362 stroke physiotherapists rated the applicability of these recommendations: 14 rated high, 7 rated low, and none were rejected. The third phase, a nominal group meeting (NGM), explored four themes related to tailoring. The first theme, “organizational factors”, includes elements such as clinical setting, culture, and regulations. The second theme, “individual clinician factors”, assesses aspects like clinical experience, expertise, abilities, knowledge, and attitudes toward tailoring. The third theme, “patient factors”, addresses issues related to multimorbidity, comorbidities, patient engagement, and shared decision-making. The final theme, “other factors”, examines the impact of research design on tailoring. Conclusions: Tailoring international clinical guidelines involves multiple factors. This situation brings home the importance of a systematic strategy for tailoring that incorporates various assessment criteria to enhance the use of clinical evidence. Future research should investigate additional implementation theories to enhance the translation of evidence into practice.