Article

This mixed-methods study examined the perceived barriers to and
facilitators of implementing best-practice guidelines (BPGs) and adhering to
provincial Quality-Based Procedures (QBPs) by Ontario physiotherapists working
with patients after total knee replacement (TKR), total hip replacement (THR),
and hip fracture (HF). Method: Using snowball sampling, 93 hospital and home care
physiotherapists working with patients after TKR, THR, or HF completed a
Web-based survey. A subset of these participated in follow-up semi-structured
telephone interviews. Results: The perception of QBP adherence varied, with
self-reported adherence rates across identified practice standards for TKR, THR,
and HF reported as 62%, 69%, and 60%, respectively. Physiotherapists generally
believed that BPGs improved outcomes; however, they identified clinical
experience as their primary guide to practice. Only 66% perceived that their
institutions met provincial standards. Barriers to BPG implementation and QBP
adherence included insufficient time, lack of access to QBPs, and limited
awareness of current BPGs. Qualitative themes included awareness and knowledge,
flexibility and funding, communication, and availability of and equitable access
to outpatient and community-based physiotherapy services. Conclusions:
Physiotherapists reported that they primarily used clinical experience to inform
care after TKR, THR, and HF, but they were also supportive of BPGs and QBPs. The
results suggest that increased access to and education about QBPs, as well as
supportive resources, could increase their integration into clinical practice.

Langue : ANGLAIS