Implementation of clinical guidelines for osteoarthritis together (IMPACT): protocol for a participatory health research approach to implementing high value care

Abstract

Background The evidence-based interventions of exercise and education have been strongly recommended as part of prominent clinical guidelines for hip and knee osteoarthritis (OA) for more than ten years. Despite the wealth of strong evidence that exists, implementation in practice is sub-optimal. This paper describes the key methodologies used in the co-design, tailoring, and evaluation of the IMPACT project implementation strategies, to confront this problem across multiple levels (micro, meso, macro) in public and private healthcare settings in Ireland. Methods Using a type III hybrid implementation-effectiveness design, a participatory, dynamic and iterative process will be used to tailor and evaluate multi-level implementation strategies using the following stages: 1) Co-design the implementation strategies with key stakeholders using best evidence, a theory-driven implementation framework (Consolidated Framework for Implementation Research), local context and expert consensus; 2) Pilot and evaluate the implementation strategies by training physiotherapists to deliver the evidence-based Good Life with osteoArthritis Denmark (GLA:D®) education and exercise programme using the implementation strategies, and conduct a mixed-methods process evaluation; 3) Adapt the implementation strategies based on implementation process evaluation indicators from stage two. The adapted strategies will be used for scale-up and sustainability in subsequent GLA:D® Ireland training programmes that will be rolled out nationally. Evaluation of effectiveness on patient and cost outcomes will continue up to 12 months post-programme delivery, using an online patient registry and pre-post design. Discussion This implementation science project aims to use participatory health research to address a gap in management of OA across public and private healthcare settings. This research has the potential to change practice and promote a policy of exercise and physical activity referral for chronic musculoskeletal disease that utilises community engagement effectively and enacts change ‘together’, with involvement of researchers, decision-makers, clinicians and patients.

Implementing lifestyle‐related treatment modalities in osteoarthritis care: Identification of implementation strategies using the Consolidated Framework for Implementation Research‐Expert Recommendations for Implementing Change matching tool

“…implementation outcomes) and on adapting the plan if necessary. An example of a detailed elaboration of these steps can be found in the recently published protocol of the IMPACT project (Toomey et al., 2022). This implementation science project will use a participatory health research approach to co‐design, tailor, pilot, evaluate, and adapt implementation strategies aiming to implement an evidence‐based exercise and education programme for hip and knee OA across public and private healthcare settings in Ireland.…”

“…This implementation science project will use a participatory health research approach to co-design, tailor, pilot, evaluate, and adapt implementation strategies aiming to implement an evidence-based exercise and education programme for hip and knee OA across public and private healthcare settings in Ireland. Because reporting the process as planned in the IMPACT project is likely to benefit 1132 meta-analysis, reproducibility, and transfer of findings to implementation science projects in other conditions, countries, and healthcare settings (Proctor et al, 2013;Toomey et al, 2022), we recommend a similar approach to optimising OA care within the Dutch context.…”

Prenatal oral health guidelines: a theory- and practice-informed approach to survey development using a modified-Delphi technique and cognitive interviews

“…This process used three rounds of a modified-Delphi technique, followed by cognitive interviews, and deliberations among the research team, SAB, and PAB members to identify, operationalize, and pre-test CFIR survey items. Many studies using the CFIR to implement and evaluate clinical practices rely largely on qualitative methods to identify salient constructs [34][35][36][37][38][39]. Our approach is unique in employing an interactive process that begins with examining all CFIR constructs to prospectively and quantitatively examine implementation barriers and facilitators [15,17].…”

Barriers and facilitators to implementation of an exercise and education programme for osteoarthritis: a qualitative study using the consolidated framework for implementation research

“…This qualitative study, as part of a larger study (IMPACT: IMPlementation of osteoArthritis Clinical guidelines Together), was conducted between 2022 and 2023. A convenience sample of PTs from different Irish healthcare settings was invited to participate in GLA:D training, with additional courses advertised nationally, across networks and clinical interest groups [ 10 ]. These PTs participated in a training course, between October 2021 and May 2022, developing essential skills and knowledge on guideline-based OA management and GLA:D Ireland protocol (e.g., delivering education, supervising neuromuscular exercise, and using the online data collection registry) [ 10 ].…”

“…Findings from 28,370 PwOA in the GLA:D data collection registry (Denmark, Canada, Australia) suggest that participation reduces pain intensity by 26–33% and improves quality of life by 12–26% [ 9 ]. To optimise healthcare service delivery for OA, GLA:D was cross-culturally adapted for implementation in Irish public and private healthcare settings using a participatory health research approach [ 10 , 11 ]. In Ireland, a two-tiered healthcare system exists (closest to the UK and Australia), where cost and access to public services are associated with an individual’s circumstance (e.g., people with low incomes may be allocated medical cards granting access to some services for free) [ 12 ].…”