Perceived determinants of clinical practice guideline implementation for stroke rehabilitation in LMICs a multinational REFORM survey

Implementation of clinical practice guidelines (CPGs) is integral to improving the quality of stroke rehabilitation in low- and middle-income countries (LMICs). However, various barriers hinder their effective utilization. This survey aimed to identify the barriers faced by rehabilitation professionals in utilizing CPGs for post-stroke motor rehabilitation. A cross-sectional survey based on the Australian Living Guidelines for Stroke Rehabilitation was developed to identify factors that influence healthcare professionals’ adherence to clinical practice guidelines. The survey comprised 50 questions spanning five domains: demographics, work practices, rehabilitation techniques, clinical practice awareness, and CPG feasibility and implementation. A panel of 10 experts validated the questionnaire. The survey was disseminated via emails, through professional associations, and platforms such as WhatsApp, LinkedIn, and X (formerly Twitter). Quantitative analysis data were analysed using Jamovi 2.3.21. The results indicated that less experienced professionals were more likely to implement CPGs, utilize telerehabilitation, and follow transition care protocols, while experienced practitioners adhered to both CPGs and hospital guidelines and employed motor outcome measures. Identified barriers included limited awareness, insufficient training, resource constraints, and challenges related to language and cultural relevance. To enhance CPG implementation, it is necessary to develop context-specific CPGs, establish stepwise clinical protocols, integrate evidence-based practice and CPG training into university curricula, and increase awareness among policymakers and stroke survivors. Engaging diverse stakeholders—patients, caregivers, multidisciplinary teams, and policymakers—is essential to foster an enabling environment for CPG adoption and advancing stroke rehabilitation practices in LMICs.