From Guideline to Practice: When the Evidence Says Yes, but the System Says No

We have access to more research and clinical guidance than ever before. But what we know doesn’t always match what happens in practice. In complex rehabilitation technology (CRT), that gap can be hard to ignore.

Equipment availability, funding, training, and opportunities for follow-up all influence what options people have access to. These are real challenges, but they can also shape our clinical decisions in ways we don’t always recognize.

When access becomes a clinical assumption

Consider a young child with significant physical disabilities who hasn’t had the opportunity to explore powered mobility. RESNA’s position paper on pediatric power mobility supports early access and challenges the use of age, cognitive ability, or visual limitations as automatic reasons to rule it out (Rosen et al., 2023).

Yet these factors may still influence whether a child is offered the opportunity to try a power wheelchair. Sometimes the hesitation reflects concerns about safety or readiness. Other times, the clinic may lack suitable trial equipment, staff training, or a clear funding pathway.

Those barriers are real. But they aren’t the same as a clinical reason to rule out an intervention. If we aren’t careful, what starts as an access problem becomes an assumption about what a person can do.

Separate the clinical question from the practical one

For a child who hasn’t explored powered mobility, we might ask whether access could support their development, participation, or independence. That’s a clinical question.

How can we arrange a meaningful trial when our clinic doesn’t have the equipment? That’s an implementation question.

Both need answers, but they shouldn’t be confused. Separating them doesn’t make the barriers disappear. It helps us identify what needs to happen next.

Maybe that means working with an equipment supplier, consulting with a clinician who has more experience in pediatric powered mobility or documenting why further assessment is needed. Sometimes there isn’t an immediate solution, but at least we’re clear about what’s standing in the way.

Guidelines are a starting point

Practice guidelines help us understand what the evidence supports, but they don’t account for every individual or every challenge within our healthcare systems. Applying them requires clinical judgment, collaboration, and sometimes a willingness to question how things have always been done.

We can’t remove every barrier to CRT access. But we can be more careful about which limitations we accept as clinical facts.

Putting It into Practice

Think about a CRT option you’ve ruled out or delayed exploring. Was that decision based on the person’s needs, or on the resources available to you? Would your clinical recommendation have been different if those barriers didn’t exist?