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Background Physiotherapists deliver evidence-based guideline recommended treatments only half of the time to patients with musculoskeletal conditions. Physiotherapists’ behaviour in clinical practice are influenced by many cognitive, social, and environmental factors including time and financial pressures. Many initiatives aimed at improving physiotherapists’ uptake of evidence-based care have failed to appreciate the context involved in clinical decisions and clinical practice. Therefore, we aimed to describe: i) opinions toward evidence; ii) how evidence is accessed; iii) factors influencing evidence access; iv) factors influencing evidence application, for physiotherapists working in regional areas. Methods We used a mixed-methods study with online survey and focus groups. We included registered physiotherapists in the survey and physiotherapists practising in regional New South Wales in the focus groups. Quantitative and qualitative data were used to inform all research objectives. We used eight domains of the Transtheoretical Domains Framework to design survey questions. We analysed quantitative and qualitative data in parallel, then integrated both sources through by developing a matrix while considering the Transtheoretical Domains Framework domains to generate themes. Results Fifty-seven physiotherapists participated in the study (survey only n = 41; focus group only n = 8; both survey and focus group n = 8). Participants reported that evidence was important, but they also considered patient expectations, colleagues’ treatment choices, and business demands in clinical decision making. Physiotherapists reported they access evidence on average 30 minutes or less per week. Competing demands like business administration tasks are barriers to accessing evidence. Participants reported that patient expectations were a major barrier to applying evidence in practice. Environmental and systemic factors, like funding structures or incentives for evidence-based care, and social factors, like lacking or having a culture of accountability and mentorship, were reported as both barriers and enablers to evidence application. Conclusions This study provides context to physiotherapists’ opinion, access, and application of evidence in clinical practice. Physiotherapists’ provision of evidence-based care may be improved by enhancing structural support from workplaces to access and apply evidence and exploring discrepancies between physiotherapists’ perceptions of patient expectations and actual patient expectations.

Background Patient‐reported outcomes and satisfaction following short length of stay (LoS) after total knee arthroplasty (TKA) in the Australian regional context remain unexplored. This study reports complications, outcomes and satisfaction of patients discharged from an enhanced recovery protocol (ERP), 6 weeks after TKA in a regional hospital. Methods Prospective recruitment occurred between 2018 and 2019. Demographics, intraoperative data, complications and emergency department (ED) presentations were retrieved from hospital records. Complications were graded for severity using a published scale. Knee range of motion (ROM), timed up‐and‐go (TUG), 6‐min walk test (6MWT) and Oxford Knee Scores (OKS) were assessed preoperatively and 6 weeks postoperatively. Patient satisfaction was assessed via questionnaire at the postoperative follow‐up. Results One hundred patients/117 primary TKAs were prospectively included. Median LoS was 2 days (interquartile range 1–3 days) with 74.4% and 88.4% of patients satisfied with their knee and LoS, at 6 weeks respectively. Twenty‐seven patients presented to the ED a total of 37 times with complication severity of Grade III or less, and 10 patients were readmitted. Significant improvements in objective and subjective outcomes were observed, however only change in median OKS exceeded the minimal clinically important difference (MCID) threshold. Conclusion An enhanced recovery protocol after TKA in a regional hospital can achieve a median LoS of 2 days without compromising patient‐reported outcomes and objective functional measures, whilst maintaining a high level of patient satisfaction with both the surgery and LoS. Further work is required to better optimize management of largely low‐grade complications in this patient population.

Outcomes following short hospital stay after total knee replacement in a regional setting: A prospective analysis of an observational cohort in a public hospital treated Abstract Functional outcomes and patient satisfaction following short length of stay (LoS) after total knee arthroplasty (TKA) in the regional context have not been explored. This study aimed to report on complications, functional outcomes and satisfaction of patients discharged from acute (≤2 days) stay, up to 6 weeks after TKA in a regional hospital.Patients were prospectively recruited from August 2018 to August 2019. Demographic data, intraoperative factors and the incidence of complications and emergency department (ED) presentations were retrieved from hospital records. Preoperative and 6 weeks postoperative assessments collected range of motion (ROM), timed up and go (TUG), 6 minute walk test (6MWT) and total Oxford knee score (OKS), with patient satisfaction assessed at follow-up via a questionnaire. A directed acyclic graph approach was used to perform logistic and linear regression to assess relationships between patient and treatment characteristics with short-term outcomes.