Physiotherapy guidelines for the management of osteoporosis – who is using them and what are the barriers to implementation?



Donaghy, Marie and Bulley, Catherine and Dow, C (2007) Physiotherapy guidelines for the management of osteoporosis – who is using them and what are the barriers to implementation? In: World Confederation of Physical Therapy Congress, 2-6 June 2007, Vancouver.

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Abstract

PURPOSE: Evidence based clinical guidelines are an important route to ensuring the transfer of evidence into practice but are physiotherapists using them? While scientific rigour underpins the development of clinical guidelines the awareness, use or clinical impact of physiotherapy clinical guidelines has not been evaluated. This study aimed to find answers to the following questions; who has access to and who is using the Chartered Society of Physiotherapy osteoporosis guideline in the UK? How is it being implemented? What are the perceived barriers to implementation? RELEVANCE: Developing guidelines is costly. This study identifies barriers to their use and makes recommendations for an action-research based process of implementation and evaluation. PARTICIPANTS: 243 physiotherapists working in the National Health Service, independent hospitals and private practice across the UK. METHODS: Survey methodology enabled the collection of numerous responses from a wide variety of geographical and clinical contexts. All aspects of the study were informed by an advisory group including representation from the National Osteoporosis Society and service users. The 26- item questionnaire was developed from the literature and piloted in three clinical sites. Closed and open questions addressed availability and use of the guideline, implementation strategies and barriers. Stratified sampling was conducted from strategic health authorities or health boards throughout the UK, and from lists of 31 independent hospitals and 102 private practitioners. Of a total random sample of 558 services, 25% responded. ANALYSIS: Descriptive analysis was performed using the SPSS version 12 and Excel. RESULTS: 62% of services had access to the guideline but only 35% were using it. Physiotherapists most frequently using the guideline included osteoporosis services (65%), specialist older people’s falls services (50%) and rheumatology services (45%). Less than 18% of physiotherapists working in out-patients, the community, and independent hospitals used the guideline. Implementation strategies were underused, when employed, the most successful were education, local opinion leaders and concensus projects. Perceived barriers to implementation were lack of resources, training, time involvement, and inapplicability to individual patients. CONCLUSIONS: Despite a relatively low response rate, results from 243 sites indicate poor awareness and use of the osteoporosis guideline throughout the UK. The lack of implementation strategies suggests that physiotherapists PURPOSE: Evidence based clinical guidelines are an important route to ensuring the transfer of evidence into practice but are physiotherapists using them? While scientific rigour underpins the development of clinical guidelines the awareness, use or clinical impact of physiotherapy clinical guidelines has not been evaluated. This study aimed to find answers to the following questions; who has access to and who is using the Chartered Society of Physiotherapy osteoporosis guideline in the UK? How is it being implemented? What are the perceived barriers to implementation? RELEVANCE: Developing guidelines is costly. This study identifies barriers to their use and makes recommendations for an action-research based process of implementation and evaluation. PARTICIPANTS: 243 physiotherapists working in the National Health Service, independent hospitals and private practice across the UK. METHODS: Survey methodology enabled the collection of numerous responses from a wide variety of geographical and clinical contexts. All aspects of the study were informed by an advisory group including representation from the National Osteoporosis Society and service users. The 26- item questionnaire was developed from the literature and piloted in three clinical sites. Closed and open questions addressed availability and use of the guideline, implementation strategies and barriers. Stratified sampling was conducted from strategic health authorities or health boards throughout the UK, and from lists of 31 independent hospitals and 102 private practitioners. Of a total random sample of 558 services, 25% responded. ANALYSIS: Descriptive analysis was performed using the SPSS version 12 and Excel. RESULTS: 62% of services had access to the guideline but only 35% were using it. Physiotherapists most frequently using the guideline included osteoporosis services (65%), specialist older people’s falls services (50%) and rheumatology services (45%). Less than 18% of physiotherapists working in out-patients, the community, and independent hospitals used the guideline. Implementation strategies were underused, when employed, the most successful were education, local opinion leaders and concensus projects. Perceived barriers to implementation were lack of resources, training, time involvement, and inapplicability to individual patients. CONCLUSIONS: Despite a relatively low response rate, results from 243 sites indicate poor awareness and use of the osteoporosis guideline throughout the UK. The lack of implementation strategies suggests that physiotherapists and users need to develop a sense of ownership in their service, with time to discuss and plan adaptations to practice where appropriate, and to provide feedback into guideline review processes. A deeper understanding of the implications of the guideline is required, especially in services such as outpatients where the direct relevance or recommendations to their clients may be less obvious. IMPLICATIONS: This survey has highlighted a problem, but the information supplied by questionnaire responses are limited in depth, making it difficult to fully understand the reasons for poor guideline implementation. An action research approach would enable the integration of implementation strategies into a cycle of investigation and change. As guidelines are integrated into practice, discussion should identify and resolve problems. There should be input from both users and non-users of clinical guidelines, and from clients affected by their use. This information could be collected using focus groups and individual interviews.

Item Type: Conference or Workshop Item (Speech)
Uncontrolled Keywords: Clinical guideline, osteoporosis, physiotherapy.
Divisions: School of Health Sciences > Physiotherapy
Date Deposited: 22 Nov 2010 11:20
Last Modified: 20 Jan 2011 08:53
URI: http://eresearch.qmu.ac.uk/id/eprint/1951

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