A mixed methods study on the barriers and enablers of implementing the Spinal Cord Injury Physiotherapy Clinical Guideline in clinical practice.

INTRODUCTION

Physiotherapy is integral in the care of people with spinal cord injury (SCI). However, physiotherapy management in SCI is potentially challenging due to the low prevalence of SCI, complexity of presentations, and broad scope of physiotherapy interventions.

OBJECTIVE

This study aimed to explore barriers and enablers of using a physiotherapy clinical guideline as perceived by therapists who deliver physical therapies to people with SCI in local health care settings.

METHOD: Following guideline dissemination, therapists were invited to participate in a survey. The survey examined barriers and enablers of following the recommendations in the physiotherapy guideline. Guided by the Theoretical Domains Framework, the survey asked participants to rate their agreement with 18 statements and to answer free-text questions about barriers and enablers. Data analysis adopted a mixed methods approach, including triangulation of quantitative and qualitative data.

RESULTS

Fifty-three therapists responded to the survey, representing regional and metropolitan health care settings, as well as public and private sectors. All respondents believed that delivering an intervention according to the guideline was worthwhile. The quantitative and qualitative findings highlighted several conditions under which therapists may find it difficult to follow guideline recommendations. These included potential conflict between patient expectations of therapy and care recommended by the guideline.

CONCLUSION

The findings offer insights into how therapists can be supported to provide evidence-based physical therapies to people with SCI in rehabilitation settings. Recommendations include targeting therapists who see few people with SCI, such as those who work in regional settings; delivering education alongside that of SCI psychosocial care; and including people with SCI as co-educators.

SPANISH ABSTRACT: http://links.lww.com/IJEBH/A363.