Confidence, attitudes, beliefs and determinants of implementation behaviours among physiotherapists towards clinical management of low back pain before and after implementation of the BetterBack model of care

Schröder, Karin; Öberg, Birgitta; Enthoven, Paul; Kongsted, Alice; Abbott, Allan

doi:10.1186/s12913-020-05197-3

Cited by 38 publications

(42 citation statements)

References 57 publications

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“…The overall facilitating role of most domains of the DIBQ-t was also reported in a Swedish study using the same questionnaire. 33 The current study findings were also in concordance with a recent implementation study in the context of LBP, which identified knowledge, beliefs about capabilities, and beliefs about consequences as relevant to implementing an online training program with a cognitive behavioral approach for LBP. 34 However, contrary to our investigation, social influences were identified as a relevant factor in two previous studies.…”

Section: Discussionsupporting

confidence: 89%

Factors influencing implementation of the GLA:D Back, an educational/exercise intervention for low back pain: a mixed-methods study

Hansen

Boyle

Myburgh

et al. 2021

JBI Evidence Implementation

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Introduction and aims: Guidelines for low back pain (LBP) management recommend patient education and exercises. GLA:D Back, a structured group-based patient-education exercise program for LBP, facilitates evidence-based care implementation. This study aimed to inform on the implementation processes, assessing clinician-related factors. Objectives were to describe profiles of implementers and nonimplementers by demographics, and responses to the tailored version of the Determinants of Implementation Behaviour Questionnaire (DIBQ-t) qualitatively explore clinician perspectives on implementation, and compare the results of the DIBQ-t with the interview data to evaluate their fit of integration for facilitators, barriers, and new insights. Methods: A mixed-methods parallel design study was conducted. Physiotherapists and chiropractors, educated in the GLA:D Back program, were asked to complete the DIBQ-t (measuring theoretical determinants of implementation) 6 months after their training. Implementers and nonimplementers of the program were selected for interviews. Qualitative data were used to understand clinicians’ viewpoints on implementation, providing a broader perspective on the quantitative data and exploring new aspects. Results: More physiotherapists than chiropractors implemented the program. Implementers responded more positively on most domains of the DIBQ-t. The interviews revealed three themes important for implementation: personal gain , practicalities, and buying-in on the program. Clinicians’ attitudes to the program appeared additionally as relevant to implementation. Conclusion: The profession of the clinician was associated with implementation behavior. Implementers and nonimplementers identified the same themes but perceived them as either positive or negative. Both groups reported high levels of knowledge and skills, indicating that training alone is insufficient for implementation.

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Section: Discussionsupporting

confidence: 89%

Factors influencing implementation of the GLA:D Back, an educational/exercise intervention for low back pain: a mixed-methods study

Hansen

Boyle

Myburgh

et al. 2021

JBI Evidence Implementation

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“…Along with the study, Schröder et al (2020) al., 2006). Therefore, it is recommended for the managers and physiotherapists to build relationships and communicate at the organizational level.…”

Section: Low Self-confidence Of Physiotherapists Toward Their Professionalismmentioning

confidence: 83%

Physiotherapy Service Without Standardized Operating Procedures From Physiotherapist’s Perspective: A Case Study

Karnadipa

2021

JAKI

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Background: Treatment variations have been considered as a sign of an inappropriate healthcare service whether due to the underuse or the overuse of resources. To reduce these variations, establishing and implementing well-developed standardized operating procedures (SOPs) and evidence-based standardized clinical guidelines is required. A rehabilitation unit for children with disabilities in Makassar did not implement any SOPs or standardized clinical guidelines in their service and treatment. This conduct may have an adverse effect on physiotherapists’ professionalism.Aims: The study aimed to explore the possible impact of community-based rehabilitation (CBR) practice with no SOPs and evidence-based standardized clinical guidelines on the physiotherapists. Method: This study was a qualitative case study. The CBR unit was observed for 278-hours and the study conducted three semi-structured interviews. Three physiotherapists voluntarily participated in the study. Open, axial, and selective coding were conducted to encode the interview findings. The findings from observation encoded interview, field, and self-reflective notes were triangulated, analyzed thematically, and illustrated by the explorative model.Results: Working with no SOPs and guidelines was associated with variations in procedures by physiotherapists, irregularity in their treatment choices, liability feeling toward errors making, and Low self-confidence in their professionalism.Conclusion: Working without SOPs and guidelines was associated with psychological exertion of the physiotherapists. They showed uncertainty in their professional capabilities as a physiotherapist. It is recommended for YPAC Makassar city to develop SOPs and evidence-based standardized clinical guidelines for their organization.Keywords: children, community-based rehabilitation, disability, guidelines, standard-operating procedure

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“…The success of implementation is complex and multifactorial concerning both clinicians and patients [ 32 , 41 – 43 ]. This present study contributes with knowledge on one of these aspects, attendance.…”

Section: Discussionmentioning

confidence: 99%

Adherence and characteristics of participants enrolled in a standardised programme of patient education and exercises for low back pain, GLA:D® Back – a prospective observational study

Hansen

Broholm

Hartvigsen

et al. 2021

BMC Musculoskelet Disord

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Background Low back pain is often long-lasting, and implementation of low-cost interventions to improve care and minimise its burden is needed. GLA:D® Back is an evidence-based programme consisting of patient education and supervised exercises for people with low back pain, which was implemented nationwide in primary care clinics in Denmark. To assess how the intervention was received and factors influencing adherence to the program, we aimed to evaluate participants’ adherence to the intervention and identified characteristics related to the completion of GLA:D® Back. Specifically, we investigated: 1) level of attendance of participants enrolled in the programme, and 2) participant-related factors associated with low attendance. Methods Primary care clinicians delivered GLA:D® Back, a standardised 10-week programme of 2 educational and 16 supervised exercise sessions, to patients with low back pain. Attendance was defined as low, medium or high based on self-reported number of attended sessions. Additional participant-reported data included demographic characteristics, pain, prognostic risk profiles, self-efficacy, illness-beliefs, function and clinician-reported physical performance tests. Results for high, medium, low, and unknown attendance were reported descriptively. Odds ratios for low attendance compared to medium/high attendance were calculated by including all baseline factors in a mixed-model logistic regression model. Results Of 1730 participants, 52% had high, 23% medium, and 25% low levels of attendance. Level of attendance was not strongly associated with participants’ individual factors, but in combination, prediction of low attendance was fair (AUC 0.77; 95% CI 0.74–0.79). The strongest indicator of low attendance was not completing the baseline questionnaire. Conclusions Most participants of a 10-week low back pain programme attended almost all session. Non-response to the baseline questionnaire was strongly associated with low attendance, whereas individual patient characteristics were weakly related to attendance. Not completing baseline questionnaires might be an early indicator of poor adherence in programs for people with persistent low back pain. Trial registration The Health Research Ethics for Southern Denmark decided there was no need for ethical approval (S-20172000-93). The Danish data collection has obtained authorisation from the Danish Data Protection Agency as part of the University of Southern Denmark’s institutional authorisation (DPA no. 2015-57-0008 SDU no. 17/30591). The trial was registred at ClinicalTrials.gov NCT03570463.

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Confidence, attitudes, beliefs and determinants of implementation behaviours among physiotherapists towards clinical management of low back pain before and after implementation of the BetterBack model of care

Cited by 38 publications

References 57 publications

Factors influencing implementation of the GLA:D Back, an educational/exercise intervention for low back pain: a mixed-methods study

Factors influencing implementation of the GLA:D Back, an educational/exercise intervention for low back pain: a mixed-methods study

Physiotherapy Service Without Standardized Operating Procedures From Physiotherapist’s Perspective: A Case Study

Adherence and characteristics of participants enrolled in a standardised programme of patient education and exercises for low back pain, GLA:D® Back – a prospective observational study

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