The aim of study was to describe the physiotherapists' experiences of an implementation process where neck-specific exercise was introduced in primary care, with or without digital support.
This study was part of a larger research project; a prospective, cluster randomized study with a hybrid 2 design aiming to implement NSE and NSEIT in primary care. Twenty physiotherapy units in primary care from seven regions in Sweden participated and were randomized to two different implementation strategies. Physiotherapists working in the units were educated in NSE and NSEIT. NSEIT was available on-line via the Swedish National Support and Treatment Services. The physiotherapists were informed that NSEIT and NSE showed good results in a former RCT targeted chronic WAD grades II and III, but they were also allowed to use it for patients with other neck pain disorders. Six focus group discussions were conducted digitally 1-2 months after education in NSE/NSEIT. Each focus group consisted of 3-5 physiotherapists working at the same unit. Qualitative content analysis with conventional approach and inductive category development was applied for data analysis.
Four main categories were developed describing the physiotherapists' experiences of the implementation process: contextual factors, implementation strategy, characteristics of the implementation object and implementation outcome. Education, collegial and organizational support were described as crucial for successful implementation. The additional tutoring, offered in one implementation strategy, was underutilized but acted as a reminder to use the method. NSE was described as an effective treatment option for both WAD and for patients with other neck pain disorders, easy to use, but with some pedagogical challenges. The physiotherapists needed allocated time to understand the digital platform and create new routines. NSEIT complemented NSE and created benefits, given that digital care suited the patient.
The findings indicated that NSE and NSEIT is integrated in clinical practices and that there is a willingness to use the program in the future. Education, time for reflection and peer support from colleagues were reported as important factors for successful implementation. NSEIT can be a valuable complement to traditional care, but utilizing digital tools in health care is still a new way of working that takes its own time and effort to implement.
The implementation of NSE and NSEIT can improve health care for persons suffering from long lasting neck pain. The results highlight the importance of allocating extra time when introducing digital tools in physiotherapy.
exercise therapy
implementation science
