Bandong AN1,2, Rebbeck T1,3, Mackey M1, Sterling M4,5, Kelly J6, Ritchie C4,5, Leaver A1
1University of Sydney, Faculty of Health Sciences, Sydney, Australia, 2University of the Philippines Manila, Department of Physical Therapy, Manila, Philippines, 3University of Sydney, John Walsh Centre for Rehabilitation Research, Sydney, Australia, 4University of Queensland, Recover Injury Research Centre, Brisbane, Australia, 5University of Queensland, Centre of Research Excellence in Road Traffic Injury Recovery, Brisbane, Australia, 6Griffith University, Menzies Health Institute Queensland, Gold Coast, Australia
Background: Clinical practice guidelines for the management of whiplash-associated disorders (WAD) have been continuously developed and updated in Australia in order to change practice and ultimately address the huge health and economic burden of the condition. The guidelines, published by the New South Wales State Insurance Regulatory Authority, advocate an evidence-based approach to the management of WAD. However, despite targeted and extensive implementation of the guidelines amongst health professionals, some practices in WAD management remain challenging to change.
Purpose: To explore acceptance of allied health professionals of key recommendations of the clinical practice guidelines for acute WAD and to identify factors that influence adherence.
Methods: This is a qualitative descriptive study involving focus group discussions amongst health professionals who treat people with WAD in the primary and secondary care settings in New South Wales and Queensland, Australia. Six focus group discussions, involving four to six participants each, were held between September and December, 2015. Results of a prior online survey were used as stimulus material and informed the questions asked during the discussions. The discussions were audio-recorded and verbatim, de-identified transcripts were produced for analysis. Thematic analysis utilising an inductive approach was conducted to analyse the data and identify commonly-held beliefs. Data saturation was deemed to have been reached upon analysis of the transcripts. Peer review amongst the research team and a member check process were done to ensure credibility of results.
Results: Twenty-eight allied health professionals who treat people with WAD, including 19 physiotherapists, 6 chiropractors and 3 osteopaths, participated in the study. There was general support for use of guidelines in clinical practice; however, in some instances, acceptance of key recommendations were mixed and seemed selective. Three main themes arose from the focus group discussions that summarise the factors that influence acceptability of guideline recommendations: guideline-related factors, practitioner and practice characteristics, and patient-related factors. Specifically, barriers to acceptance included ambiguity in some recommendations, inconsistent beliefs and practices, as well as expectations and characteristics of people with WAD.
Conclusion(s): Overall, allied health professionals are generally supportive of using guidelines in clinical practice. However, acceptance of key recommendations appeared mixed and in some cases conditional. These results suggest that future revisions of the guidelines might emphasise the underlying principles of the guidelines and provide more detailed and action-orientated recommendations. Implementation of the guidelines might also involve strategies that promote more informed-decision making for people with WAD and challenge inconsistent beliefs of health professionals.
Implications: Results of this study provide a deeper understanding of the factors that influence health professionals in their decisions to use and apply guidelines in clinical practice. These results could inform future revisions and implementation strategies to enhance guideline uptake and adherence.
Keywords: Guideline adherence, whiplash injuries, primary health care
Funding acknowledgements: This project was funded by the New South Wales State Insurance Regulatory Authority and the Queensland Motor Accident Insurance Commission.
Purpose: To explore acceptance of allied health professionals of key recommendations of the clinical practice guidelines for acute WAD and to identify factors that influence adherence.
Methods: This is a qualitative descriptive study involving focus group discussions amongst health professionals who treat people with WAD in the primary and secondary care settings in New South Wales and Queensland, Australia. Six focus group discussions, involving four to six participants each, were held between September and December, 2015. Results of a prior online survey were used as stimulus material and informed the questions asked during the discussions. The discussions were audio-recorded and verbatim, de-identified transcripts were produced for analysis. Thematic analysis utilising an inductive approach was conducted to analyse the data and identify commonly-held beliefs. Data saturation was deemed to have been reached upon analysis of the transcripts. Peer review amongst the research team and a member check process were done to ensure credibility of results.
Results: Twenty-eight allied health professionals who treat people with WAD, including 19 physiotherapists, 6 chiropractors and 3 osteopaths, participated in the study. There was general support for use of guidelines in clinical practice; however, in some instances, acceptance of key recommendations were mixed and seemed selective. Three main themes arose from the focus group discussions that summarise the factors that influence acceptability of guideline recommendations: guideline-related factors, practitioner and practice characteristics, and patient-related factors. Specifically, barriers to acceptance included ambiguity in some recommendations, inconsistent beliefs and practices, as well as expectations and characteristics of people with WAD.
Conclusion(s): Overall, allied health professionals are generally supportive of using guidelines in clinical practice. However, acceptance of key recommendations appeared mixed and in some cases conditional. These results suggest that future revisions of the guidelines might emphasise the underlying principles of the guidelines and provide more detailed and action-orientated recommendations. Implementation of the guidelines might also involve strategies that promote more informed-decision making for people with WAD and challenge inconsistent beliefs of health professionals.
Implications: Results of this study provide a deeper understanding of the factors that influence health professionals in their decisions to use and apply guidelines in clinical practice. These results could inform future revisions and implementation strategies to enhance guideline uptake and adherence.
Keywords: Guideline adherence, whiplash injuries, primary health care
Funding acknowledgements: This project was funded by the New South Wales State Insurance Regulatory Authority and the Queensland Motor Accident Insurance Commission.
Topic: Professional issues; Musculoskeletal: spine; Primary health care
Ethics approval required: Yes
Institution: The University of Sydney and Griffith University
Ethics committee: Human Research Ethics Committees
Ethics number: Protocol number: 2015/444 and Protocol number: 2015/707
All authors, affiliations and abstracts have been published as submitted.
