Physiotherapy guidelines for the management of osteoporosis - who is using them and what are the barriers to implementation?
2007
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.
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