Qualitative study of barriers and facilitators to rapid adaptation in first contact physiotherapy services in the UK and Australia.

Karen Stenner, Oluwatoyin Adeniji, Evangelos Pappas, Victoria Traynor, Nicola Carey, Theti Chrysanthaki
Purpose:

This study explores the barriers and facilitators to the rapid adaptation of first contact physiotherapy services for musculoskeletal patients  during the COVID 19 pandemic in the UK and Australia.

Methods:

Physiotherapists in first contact roles, along with key stakeholders (including managers, doctors, nurses, and support staff) from primary care and emergency departments in the UK and Australia, respectively, were purposively selected for the study. One-time, individual online semi-structured interviews were conducted via MS Teams or Zoom between August 2023 and January 2024. A framework analysis was carried out, mapping the barriers and facilitators to the rapid adaptation of first contact physiotherapy services during the pandemic, using the Consolidated Framework for Implementation Research (CFIR)

Results:

A total of 22 physiotherapists and stakeholders participated in the study, with 10 from the UK and 12 from Australia. Participants reported service disruptions, including the shutdown of services (primarily in primary care), reduced operations, and fewer presentations of MSK patients in both primary care and emergency departments. Despite these challenges, first-contact physiotherapy services adapted rapidly within the first six months of the COVID 19 pandemic. Key adaptations included the increased use of telehealth, service restructuring, redeployments, and the use of personal protective equipment.

Through the application of the CFIR, barriers and facilitators were identified across its domains. Additionally, five new factors emerged that had not been previously recognised by CFIR: uncertainties around the pandemic, contingencies, decision-making, duplication of effort, lack of job satisfaction, and the need for touch. These factors were grouped into three key themes: 1) changes in healthcare service delivery, 2) sustainability of change, and 3) readiness for change.

Conclusion(s):

This study demonstrates that while first-contact physiotherapy services for MSK conditions faced disruptions during the initial phase of the COVID 19 pandemic, they were able to adapt their services within six months of the pandemic's declaration. However, barriers related to preparedness may have delayed their immediate response and impacted the sustainability of these changes.

Implications:

As efforts continue to improve the rapid adaptation and continuity of healthcare services during public health emergencies, this study offers important insights into the factors influencing these processes in first contact physiotherapy services for MSK patients. These findings can inform policies aimed at enhancing the preparedness of healthcare services. The study also highlights the need for future implementers to focus on strengthening facilitators and addressing significant barriers to implementation.

Funding acknowledgements:
This is part of a PhD-project jointly funded by the University of Surrey, UK and the University of Wollongong, Australia
Keywords:
Implementation
First contact physiotherapy
Musculoskeletal
Primary topic:
Service delivery/emerging roles
Second topic:
Research methodology, knowledge translation and implementation science
Third topic:
Musculoskeletal
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Health Research Authority, UK and Human Research Ethics Committee at the University of Wollongong, Australia.
Provide the ethics approval number:
23/NW/0200 and 2023/ETH00538
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?:
No

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