Understanding Barriers to the Use of a Low Back Pain Clinical Practice Guideline in Physical Therapist Practice: A Mixed-Methods Approach.

Abstract

Importance: Low adherence rates to low back pain (LBP) clinical practice guidelines (CPGs) by physical therapists have been reported in the United States (US); however, no studies have explored barriers to their use.

Objective: The aim of this study was to explore perceived barriers physical therapists face for implementing the most recent LBP CPG from American Physical Therapy Association Orthopaedic.

Design: This was a convergent parallel mixed-methods design.

Setting: This was completed virtually.

Participants: A total of 173 US outpatient physical therapists completed the survey, with 20 participating in focused interviews.

Intervention(s) or exposure(s): Participants completed an online survey and semi-structured virtual interviews.

Main outcome(s) and measure(s): The primary outcomes were the top barriers identified through survey data and thematic analysis of interviews. A thematic analysis was implemented for the qualitative analysis. A binary logistic regression was used to model relationships between demographic variables, barriers, and CPG use.

Results: Six themes related to barriers to CPG implementation were identified through interviews including a lack of individualized care, a lack of skills/confidence, patient expectations/perceptions, previous experience, time limitations, and proper understanding of the guidelines. Participants who completed an orthopaedic residency program were more likely to report the barrier of "difficulties with 1-on-1 care" (OR = 8.70, 95% CI = 2.12-39.22). Individuals practicing between 1 to 5 years (OR = 7.49, 95% CI = 1.39-52.75) compared to 20+ years and those reporting regular use of the CPG (OR = 5.81, 95% CI = 1.99-21.51) were more likely to report the barrier of "concern for patient's response."

Conclusion: Novice clinicians and those who completed orthopaedic residency reported barriers to CPG use. Six major themes related to barriers for implementing the CPG were identified, consistent with majority of the barriers reported in the survey, demonstrating the convergence of analyses. The most common barrier was the perception of sacrificing individualized care.

Impact: This study may help improve adoption and implementation of CPGs in real-world clinical practice settings.