TAILORED TRAINING FOR PHYSIOTHERAPISTS ON CLINICAL PRACTICE GUIDELINE UTILISATION: A MIXED METHODS STUDY

J. Stander¹, K. Grimmer¹, Y. Brink¹

Background: Clinical practice guidelines (CPG) are vehicles for translating research evidence into practice, but effective CPG-uptake requires targeted training. A multi-faceted KT strategy using an evidence-based tailored training programme (TTP) has not previously been reported for physiotherapists working in resource-limited, South African primary care settings.

Purpose: This research project aimed to develop and evaluate a TTP that addressed factors influencing CPG uptake by South African physiotherapists treating clients with low back pain in primary healthcare settings.

Methods: A multi-stage intervention mixed methods research design was used. A theoretical framework informed by the Implementation of Change model guided the study. Data integration through narrative occurred through a staged approach. Three set-up phases informed the content and delivery method of the draft TTP, consisting of two literature scoping reviews, and individual interviews exploring physiotherapists’ perceptions of, and experiences with, CPG use. An expert validation study confirmed the TTP content and delivery methods. The feasibility of the TTP was then evaluated, and this final phase collected and analysed participants’ discussions during the TTP. The qualitative interview data was used to build the quantitative survey items to evaluate participants’ self-perception of CPG use and understanding of CPGs. Ten Continuing Professional Development points were allocated to the TTP.

Results: The evidence-based TTP consisted of a one-day interactive face-to-face knowledge translation session, preceded by six preliminary podcasts (one-hour total), each designed around participants’ knowledge needs, attitudes and time constraints. Self-evaluation activities occurred before, and after the TTP. There were 11 participants in the feasibility study, who all worked in rural South African primary healthcare. Pre-TTP evaluations highlighted their scepticism towards CPG-use in clinical practice, with most participants seemingly unaware of the nature and intent of CPGs, how CPGs are constructed, accessed, implemented or evaluated. However, most participants identified areas of clinical practice where they required guidance, and all indicated an interest in learning more about providing evidence-based care. Immediate post TTP evaluations showed improvements in knowledge, attitudes and skills in CPGs. Overall feedback was that the TTP was of unanticipated value in assisting participants to use CPGs to better manage clients with low back pain. Post TTP follow-up demonstrated significant behaviour change by participants in regular CPG use, not just to treat clients with low back pain, but to manage clients with other challenging conditions.

Conclusion(s): The phased-construction of the TTP ensured that it addressed South African primary healthcare physiotherapists’ needs and concerns on CPG uptake, using validated evidence-based educational approaches. The TTP content, delivered by podcasts and face-to-face contact, was feasible and acceptable in terms of physiotherapists’ time constraints, and it appeared to be effective in improving all outcome domains. The Continuing Professional Development points were considered attractive, and an incentive to participation. Limitations of the study, affecting the generalisability of the findings, were a small sample size and a limited geographical area.

Implications: This TTP can now be implemented in a large-scale intervention study. The process followed in this project can be used in resource-limited settings to contextualise training to educate clinicians on CPG utilisation.

Funding, acknowledgements: The authors received financial support from Stellenbosch University internal funds (K1811; 52113).

Keywords: Knowledge translation, Clinical practice guidelines, Mixed methods

Topic: Research methodology, knowledge translation & implementation science

Did this work require ethics approval? Yes

Institution: Stellenbosch University

Committee: Health Research Ethics Committee

Ethics number: S17/05/100