Physiotherapists' experiences of the implementation of neck-specific exercise for patients with chronic neck pain: A qualitative study.

OBJECTIVES

A neck-specific exercise programme (NSE) for whiplash-associated disorders has shown good results in randomized controlled trials. The results were as good when delivered on-site as delivered via internet (NSEIT). Health care practitioners' experiences can provide valuable insights into factors contributing to successful implementation. The aim of this study was to describe physiotherapists' experiences of the implementation of NSE and NSEIT in primary care physiotherapy for patients with chronic neck pain.

DESIGN

A qualitative study based on focus group discussions, analysed with qualitative content analysis and inductive category development.

SETTING

This study was part of a cluster-randomized study aiming to implement NSE and NSEIT. Twenty physiotherapy units in primary care in Sweden were randomized to two different implementation strategies.

PARTICIPANTS

Six focus group discussions, each with three to five physiotherapists working at the same physiotherapy unit, were conducted after the implementation activities were ended.

RESULTS

Categories developed in the analysis were: contextual factors, implementation strategy, characteristics of the implementation object and implementation outcome. The physiotherapists reported that they had integrated NSE into their clinical practice, but NSEIT was more challenging to implement. The positive characteristics of NSE, education, time for reflection and collegial support were described as vital for the successful implementation.

CONCLUSIONS

The findings suggest an implementation strategy with education containing theoretical background and practical training to promote the implementation of NSE. Internet delivery may complement NSE, but requires additional time and effort to implement. CONTRIBUTION OF THE PAPER.