Developing spinal cord injury physiotherapy clinical practice guidelines: a qualitative study to determine how physiotherapists and people living with spinal cord injury use evidence

Spinal Cord, 2023 · DOI: 10.1038/s41393-022-00867-x · Published: December 13, 2022

Spinal Cord Injury Rehabilitation Research Methodology & Design

Simple Explanation

This study explores how physiotherapists and people with spinal cord injuries (SCI) use evidence when choosing treatments. It looks at the factors that influence these decisions and identifies potential barriers and facilitators for implementing clinical practice guidelines (CPGs). The research involved interviews and focus groups with physiotherapists and people with SCI in Australia and New Zealand. The study identified the types of evidence used, the factors influencing treatment choices, and ways CPGs could influence treatment. The findings suggest that CPGs have the potential to help physiotherapists access and use research evidence more effectively. However, successful implementation of CPGs requires addressing various barriers and considering the multiple factors that influence treatment decisions.

Study Duration

3-year project

Participants

75 participants: 45 physiotherapists and 30 people living with spinal cord injury

Evidence Level

Qualitative study

Key Findings

1
Physiotherapists use a broad range of evidence, including clinical expertise, peer advice, and published research, when making treatment choices for people with SCI.
2
Treatment choices are influenced by various factors beyond evidence, such as patient goals, funding, availability of equipment, and personal injury characteristics.
3
Clinical practice guidelines (CPGs) are seen as potentially useful, especially for less experienced physiotherapists, but their adoption depends on their usability, accessibility, and ability to reflect the complexities of SCI.

Research Summary

This qualitative study investigated how physiotherapists and people living with spinal cord injury (PLwSCI) use evidence in making treatment decisions. It identified three main themes: types and sources of evidence, factors influencing treatment choices, and the potential influence of clinical practice guidelines (CPGs). The study found that physiotherapists rely on a mix of clinical expertise, peer advice, and research evidence, while PLwSCI often turn to clinicians, the internet, and peer-based sites for information. Treatment decisions are influenced by a range of factors beyond evidence, including patient goals and resource availability. Participants generally welcomed the development of physiotherapy-specific CPGs for SCI, but highlighted the need for clear, accessible, and regularly updated guidelines that reflect the complexities of SCI and are adaptable to different clinical settings.

Practical Implications

Guideline Development

The findings underscore the need for CPGs to be developed in consultation with both physiotherapists and PLwSCI to ensure they are relevant and address the factors influencing treatment decisions.

Implementation Strategies

Effective implementation strategies are crucial for promoting the uptake of CPGs, including education, the use of clinical champions, and embedding CPGs into university curricula.

Resource Allocation

Addressing organizational barriers, such as funding restrictions and limited access to resources, is essential for enabling physiotherapists to implement evidence-based practices and CPG recommendations.

Study Limitations

1
Some face-to-face interviews were conducted over the telephone due to COVID-19 restrictions.
2
Different interviewers were used in Australia and New Zealand.
3
Coding and themes were independently extracted for the Australian and New Zealand data.

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