Behavioural change strategies increase physiotherapists’ adherence to Inspiratory Muscle Training for people with SCI: a pre-post study

Keira Tranter, Lisa Harvey, Lynn Blecher, Lydia Chen, Jacqui White, Jamie Li, Claire Boswell-Ruys, Marnie Graco, David Berlowitz, Joanne Glinsky
Purpose:

The aim of the study was to evaluate the adherence of physiotherapists to the provision of IMT as recommended in the CPG. The secondary aim was to develop, implement and evaluate targeted strategies to increase physiotherapists’ provision of IMT for people with SCI and respiratory muscle weakness.The aim of the study was to evaluate the adherence of physiotherapists to the provision of IMT as recommended in the CPG. The secondary aim was to develop, implement and evaluate targeted strategies to increase physiotherapists’ provision of IMT for people with SCI and respiratory muscle weakness.

Methods:

A mixed-methods pre-post study was carried out within three Spinal Injuries Units (SIU) in Sydney, Australia. Interviews and focus groups were conducted using the Theoretical Domains Framework (TDF) to evaluate the barriers and facilitators to the provision of IMT by physiotherapists. Qualitative data were analysed and then mapped to the Capability, Opportunity, Motivation- Behaviour (COM-B) model to identify specific behavioural change strategies. These strategies were implemented over a 6-week intensive implementation period. Physiotherapists’ adherence was measured using a structured guideline audit tool before, immediately following and two months after the implementation period. Intervention fidelity of IMT was also explored.

Results:

Physiotherapists’ initial rates of IMT provision were 20%, therefore identifying an evidence-practice gap. Key barriers to the provision of IMT included physiotherapists’ perceived lack of skill, knowledge and confidence in delivering IMT, support from the service delivery model, time and resources. The results from the TDF were then mapped to the COM-B model to determine targeted implementation strategies. The main strategies focused on education, training, service provision, environmental restructuring, monitoring and modelling. Physiotherapists’ rates of IMT provision were 91% immediately and 75% two months following the 6-week intensive implementation period.

Conclusion(s):

The targeted behavioural change strategies improved physiotherapists’ adherence to guideline recommendations for the provision of Inspiratory Muscle Training to people with SCI.

Implications:

The implementation strategies identified in this study can be adapted and implemented within differing health contexts to improve physiotherapists’ provision of IMT, as recommended in the CPG. Further research is warranted to determine the additional benefit of targeted strategies to improve guideline adherence among physiotherapists versus more traditional methods of dissemination, and to examine long-term changes in behaviour.

Funding acknowledgements:
The Clinical Practice Guidelines were funded by Icare NSW, Transport Accident Commission, National Injury Insurance Scheme Queensland and Lifetime Support.
Keywords:
spinal cord injury
physiotherapy
respiratory interventions
Primary topic:
Neurology: spinal cord injury
Second topic:
Disability and rehabilitation
Third topic:
Research methodology, knowledge translation and implementation science
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Northern Sydney Local Health District, Human Ethics Committee, Royal North Shore Hospital, St Leonards, Sydney Australia.
Provide the ethics approval number:
2022/ETH00991
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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