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One knowledge translation method, of putting evidence into practice, is the use of clinical practice guidelines (CPG). The purpose of this brief report is to describe an 8‐step process of "how to" contextualize a training programme to increase CPG‐uptake for a targeted audience in a clearly defined setting. This process may assist implementation practitioners to fast‐track the development of contextualized training to improve CPG‐uptake. [ABSTRACT FROM AUTHOR]

Background: Lack of time has consistently been reported as a major barrier to effective research evidence uptake into clinical practice. There has been no research to our knowledge that explores time as a barrier within the transtheoretical model of stages of change (SoC), to better understand the processes of physiotherapists' uptake of clinical practice guidelines (CPGs). This article explores the concept of lack of time as a barrier for CPG uptake for physiotherapists at different SoC. Methods: A six‐step process is presented to determine the best‐fit SoC for 31 physiotherapy interviewees. This process used an amalgamation of interview findings and socio‐demographic data, which was layered onto the SoC and previously identified time‐barriers to CPG uptake (few staff, high workload, access to CPGs, evidence‐based practice as priority in clinical practice, 'time is money' attitude and knowledge on the use of CPGs). Results: The analysis process highlighted the complexities of assigning individuals to a SoC. A model of time management for better CPG uptake is proposed which is a novel approach to assist evidence implementalists and clinicians alike to determine how to progress through the SoC and barriers to improve CPG uptake. Conclusions: To the authors' knowledge, this is the first attempt at exploring the construct of (lack of) time for CPG uptake in relation to the physiotherapists' readiness to behaviour change. This study shows that 'lack of time' is a euphemism for quite different barriers, which map to different stages of readiness to embrace current best evidence into physiotherapy practice. By understanding what is meant by 'lack of time', it may indicate specific support required by physiotherapists at different stages of changing these behaviours. [ABSTRACT FROM AUTHOR]

Objective This paper explores the economic value of rehabilitation to South Africa, using a costed example of cerebrovascular accident (CVA) (stroke) rehabilitation. Design We report an economic modelling approach using a worked cost‐effectiveness to validate the argument for the cost‐saving benefits of stroke rehabilitation. Setting: South African health care, employing analysis of available secondary data from South African research and government reports. Participants: In line with international trends in stroke epidemiology, we focused on people who were employed prior to having their stroke, with return‐to‐work as the desired rehabilitation outcome. Interventions: Not applicable. Main outcome measure(s): We used information on stroke rehabilitation and secondary data derived from grey and published literature, to determine if early stroke rehabilitation represents value for money from the government perspective. For our worked example, we used return‐to‐work rates, intervention costs, and the cost of rehabilitation services to estimate cost‐savings as a result of an individualized workplace intervention. Results: The cost of delivering the individualized intervention was estimated at R5633/patient. Combining survivor rates, return‐to‐work rate, and costs of the programme, a work intervention programme could result in a net saving of R133.1 million over 5 years (or about R26.6 per year (discount 3%). Conclusion: The value of rehabilitation should not be considered in terms of cost‐effectiveness alone, but also as an investment for the country. A staged, prioritized approach should be considered in future South African national health budget. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Most frailty assessments have been developed for people aged over 65 years. However, there is growing evidence that frailty is detectable in younger people. This paper tests the hypothesis that the Fried frailty phenotype and the CFS categories identify the same people in age‐gender subgroups in community‐dwelling 40 to 75‐year‐olds. Method: Participants were recruited via comprehensive community‐sampling strategies. They self‐reported frailty using the Clinical Frailty Scale (CFS), and frailty was also estimated using the Fried phenotype (self‐reported unintended weight loss, exhaustion and low regular exercise; observed slow gait speed and poor grip strength). CFS and Fried scores were compared overall, and for age‐gender subgroups (40‐49 years, 50‐59 years, 60‐69 years, and 70‐75 years). Spearman rho and differences in mean integer Fried scores were calculated across CFS categories using ANOVA. Correlations were determined between Fried categories of not‐frail, pre‐frail, and frail and ranked CFS categories, using ranked scores (tau‐c) and Cochran‐Mantel‐Haenszel (C‐M‐H) tests. Results: Of 656 participants (67% female; mean age 59.9 years, SD 10.6), Fried phenotype classified 59.2% not frail, 39.0% pre‐frail, and 1.8% frail, with no gender or age differences. CFS data were missing for 25 participants, with N = 631 reporting categories of very well (24.6%), well (44.6%), managing well (21.9%), vulnerable (6.3%), mildly frail (0.5%), and moderately frail (0.2%). Overall, the mean Fried frailty scores increased incrementally and significantly across ranked CFS categories (P <.01), with weak linear correlation (rho = 0.09). There were variable correlations in age‐gender groups, with the best correlation found for women aged 50 years or older, and men aged 60 to 69 years. Conclusion: Frailty assessments using the two assessments became more consistent, as age increased. Pre‐frailty was identified by both assessments in all age‐gender groups. The validity of self‐reported CFS, and of pre‐frailty criteria relevant to people younger than 65 years, needs investigation. [ABSTRACT FROM AUTHOR]

Rationale: Clinical practice guidelines (CPGs) should provide busy health care professionals with easy‐to‐use tools that support efficient uptake of current best evidence in daily clinical practice. However, CPG uptake rarely occurs at the speed of evidence production. The aim of this study was to explore the factors influencing CPG uptake among South African (SA) physiotherapists (PTs). Method: An exploratory, descriptive qualitative study design was used, within an interpretative research paradigm. A phenomenological approach was taken, as the study aimed to explore the phenomenon of CPG uptake by SA PTs and how the themes and subthemes related to each other within this phenomenon. Semistructured interviews were undertaken via telephone calls that were audiotaped and independently transcribed. An inductive and deductive thematic content analysis approach was taken where the transcript content was analysed by hand. Findings Thirty‐one PTs from the private, public, and education sectors participated in the interviews. The main themes identified were resources, training, and organizational factors. The SA PT workforce, particularly that in the public sector, is limited and patient load and need is high. Time to implement and stay up‐to‐date with current evidence were barriers for many interviewees. Participants also perceived CPG uptake as not being financially rewarding. Training in CPG uptake was mostly perceived as a facilitator, and the PTs felt that they would be more inclined to implement CPGs if they felt more confident in how to source and use CPGs, particularly if they were incentivized to undertake such training. Roles, responsibilities, and power in the health care team were perceived as being both organizational barriers and, conversely, facilitators, depending on work environments. Conclusions: The findings of this study generally concur with previous studies about PT barriers to CPG uptake; however, it provides novel information on barrier contexts in one LMIC with complex PT service delivery. [ABSTRACT FROM AUTHOR]

Background: Chemical restraint (CR) (also known as rapid tranquilisation) is the forced (non‐consenting) administration of medications to manage uncontrolled aggression, anxiety, or violence in people who are likely to cause harm to themselves or others. Our population of interest was adults with mental health disorders (with/without substance abuse). There has been a growing international movement over the past 22 years towards reducing/eliminating restrictive practices such as CR. It is appropriate to summarise the research that has been published over this time, identify trends and gaps in knowledge, and highlight areas for new research to inform practice. Aims: To undertake a comprehensive systematic search to identify, and describe, the volume and nature of primary international research into CR published since 1995. Methods: This paper reports the processes and overall findings of a systematic search for all available primary research on CR published between 1 January 1996 and 31 July 2018. It describes the current evidence base by hierarchy of evidence, country (ies) producing the research, CR definitions, study purpose, and outcome measures. Results: This review identified 311 relevant primary studies (21 RCTs; 46 non‐controlled experimental or prospective observational studies; 77 cross‐sectional studies; 69 retrospective studies; 67 opinion pieces, position or policy statements; and 31 qualitative studies). The USA, UK, and Australia contributed over half the research, whilst cross‐country collaborations comprised 6% of it. The most common research settings comprised acute psychiatric wards (23.3%), general psychiatric wards (21.6%), and general hospital emergency departments (19.0%). Discussion A key lesson learnt whilst compiling this database of research into CR was to ensure that all papers described non‐consenting administration of medications to manage adults with uncontrolled aggression, anxiety, or violence. There were tensions in the literature between using effective CR without producing adverse events, and how to decide when CR was needed (compared with choosing non‐chemical intervention for behavioural emergencies), respecting patients' dignity whilst safeguarding their safety, and preserving safe workplaces for staff, and care environments for other patients. The range of outcome measures suggests opportunities to standardise future research. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Good‐quality clinical practice guidelines (CPGs) provide recommendations based on current best‐evidence summaries. Hypertension is a prevalent noncommunicable disease in Africa, with disastrous sequelae (stroke, heart, and kidney disease). Its effective management relies on good quality, current, locally relevant evidence. This paper reports on an all African review of the guidance documents currently informing hypertension management. Methods: Attempts were made to contact 62 African countries for formal guidance documents used nationally to inform diagnosis and management of hypertension. Their quality was assessed by using Appraisal of Guidelines for Research & Evaluation (AGREE) II, scored by 2 independent reviewers. Differences in domain scores were compared between documents written prior to 2011 and 2011 onward. Findings were compared with earlier African CPG reviews. Results: Guidelines and protocols were provided by 26 countries. Six used country‐specific stand‐alone hypertension guidelines, and 10 used protocols embedded in Standard Treatment Guidelines for multiple conditions. Six used guidelines developed by the World Health Organization, and 4 indicated ad hoc use of international guidance (US, Portugal, and Brazil). Only 1 guidance document met CPG construction criteria, and none scored well on all AGREE domain scores. The lowest‐scoring domain was rigour of development. There was no significant quality difference between pre‐2011 and post‐2011 guidance documents, and there were variable AGREE II scores for the same CPGs when comparing the African reviews. Conclusions: The quality of hypertension guidance used by African nations could be improved. The need for so many guidance documents is questioned. Adopting a common evidence base from international good‐quality CPGs and layering it with local contexts offer 1 way to efficiently improve African hypertension CPG quality and implementation. [ABSTRACT FROM AUTHOR]