Factors influencing the use of evidence in physical therapy A multilevel exploration in the context of multidisciplinary rehabilitation for patients suffering from diabetes or stroke

Chapter 2 discusses the feasibility and preliminary effectiveness of tailoring general scientific recommendations on exercise for patients with diabetes into a program for patients with multiple diabetic complications. Chapter 3 is a case report providing a detailed description of the individual adjustments and prerequisites required to ensure safety and effectiveness when tailoring general scientific recommendations to a patient with multiple diabetic complications. In Chapters 2 & 3 we provide in-depth information at the patient level and discuss the organizational and professional conditions needed to effectively carry out an exercise program for patients with diabetes and multiple complications. Chapter 4 examines early in-patient stroke rehabilitation based on a survey among physical therapists in the stroke units of Dutch hospitals. It discusses the organization of care and the current practice with respect to early mobilization and augmented exercise therapy time. The study presented in this chapter also aimed to identify the perceived barriers and facilitators for the use of the clinical practice guideline. The chapter addresses both the patient and the organizational level. Chapter 5 reports on the process of establishing recommendations for relevant and feasible measurement instruments in the clinical practice guideline for patients with stroke, which was revised by a team of physical therapists and researchers. This chapter thus addresses the innovation level. Chapter 6 focusses on the use of the stroke guideline in the clinical reasoning of physical therapists. This chapter describes the development of an instrument to measure guideline-consistent clinical reasoning. In addition, the study assessed the validity of the instrument and factors related to guideline-consistent clinical reasoning. This chapter mainly addresses the level of the professional. The general discussion, Chapter 7, summarizes the main findings reported in this thesis, as well presenting implications and suggestions for future research and offering further considerations on implementation.