Abstract
Background Although the increasing complexity and expansion of the body of knowledge in physical therapy have led to specialized practice areas to provide better patient care, the impact of specialization on guideline implementation has been scarcely studied.
Objectives The objective of this study was to identify the similarities and differences in barriers to the implementation of a Dutch rheumatoid arthritis (RA) guideline by generalist and specialist physical therapists.
Design This observational study consisted of 4 focus group interviews in which 24 physical therapists (13 generalist and 11 specialist physical therapists) participated.
Methods Physical therapists were asked to discuss barriers to the implementation of the RA guideline. Data were analyzed qualitatively using a directed approach to content analysis. Both the interviews and the interview analysis were informed by a previously developed conceptual framework.
Results Besides a number of similarities (eg, lack of time), the present study showed important, although subtle, differences in barriers to the implementation of the RA guideline between generalist physical therapists and specialist physical therapists. Generalist physical therapists more frequently reported difficulties in interpreting the guideline (cognitive barriers) and had less favorable opinions about the guideline (affective barriers) than specialist physical therapists. Specialist physical therapists were hampered by external barriers that are outside the scope of generalist physical therapists, such as a lack of agreement about the roles and responsibilities of medical professionals involved in the care of the same patient.
Conclusions The identified differences in barriers to the implementation of the RA guideline indicated that the effectiveness of implementation strategies could be improved by tailoring them to the level of specialization of physical therapists. However, it is expected that tailoring implementation strategies to barriers that hamper both generalist and specialist physical therapists will have a larger effect on the implementation of the RA guideline.
Footnotes
Dr Verhoef, Ms Dickmann, Ms Kleijn, Ms van Vliet, Dr Hurkmans, Dr van der Wees, and Dr Vliet Vlieland provided concept/idea/research design. Dr van Bodegom-Vos, Dr Verhoef, and Dr Vliet Vlieland provided writing. Ms Kleijn, Ms Dickmann, Ms van Vliet, and Dr Hurkmans provided data collection. Dr van Bodegom-Vos, Dr Verhoef, Ms Dickmann, Ms Kleijn, and Ms van Vliet provided data analysis. Dr Verhoef and Dr van der Wees provided project management. Ms Kleijn, Ms Dickmann, and Ms van Vliet provided study participants. Dr Verhoef and Dr Vliet Vlieland provided institutional liaisons. Dr Verhoef, Dr Hurkmans, Dr van der Wees, and Dr Vliet Vlieland provided consultation (including review of manuscript before submission). Dr van der Wees is an employee of the Royal Dutch Society for Physical Therapy (KNGF), which issued the development of the rheumatoid arthritis guideline. The authors are indebted to Florus van der Giesen, PT, PhD, who gave advice and training on the conduct of focus groups.
- Received March 29, 2011.
- Accepted June 15, 2012.
