Implementation context of outpatient physical therapy clinics preparing to launch a new evidence-based clinical program for knee osteoarthritis: Findings from a national multisite implementation trial.

Abstract

Objective: We evaluated implementation context to identify barriers and facilitators to delivering a new evidence-based clinical program, Group physical therapy (Group PT) for knee osteoarthritis, overall and by rurality and facility complexity.

Design: Baseline surveys from an implementation trial of Group PT.

Setting: Outpatient PT clinics (n=19) in the Veterans Health Administration.

Participants: Staff at Group PT sites (n=59).

Main outcome measures: Validated measures of implementation context included: organizational readiness to implement change (ORIC; score range 1-5), organizational resilience via the benchmark resilience tool (BRT; score range 8-32) and implementation climate scale (ICS; score range 0-4); surveys also included questions regarding anticipated challenging and helpful factors for implementing Group PT.

Results: Mean scores on the ORIC (4.6, SD=0.4) and BRT (26.2, SD=2.9) did not vary substantially by rurality or facility complexity. For the ICS, mean scores were lower for low complexity vs high complexity sites (2.0, SD=0.4 vs 2.6, SD=0.6) and lower for high rurality vs low rurality sites (1.9, SD=0.4 vs 2.5, SD=0.6). The most endorsed challenging factors were lack of experience implementing new programs (49%), staffing (47%) and patient awareness (45%). The most endorsed helpful factors were guidance on starting the program (96%), program effectiveness (96%) and staff resources (93%).

Conclusions: Based on ORIC and BRT scores, staff perceived high levels of preparedness to implement Group PT, but they also identified specific factors that could make implementation challenging. Rural and low complexity sites reported lower levels of organizational prioritization for implementing evidence-based practices and may benefit from additional support.