Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, UK.
Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK; The George Institute for Global Health, University of Oxford, Oxford, UK.
Physiotherapy. 2018 Mar;104(1):107-115. doi: 10.1016/j.physio.2017.03.007. Epub 2017 Jun 1.
Our objectives were two-fold: (i) to describe physiotherapists' experiences of implementing a cognitive behavioural approach (CBA) for managing low back pain (LBP) after completing an extensive online training course (iBeST), and (ii) to identify how iBeST could be enhanced to support long-term implementation before scale up for widespread use.
We conducted semi-structured interviews with 11 physiotherapists from six National Health Service departments in the Midlands, Oxfordshire and Derbyshire. Questions centred on (i) using iBeST to support implementation, (ii) what barriers they encountered to implementation and (iii) what of information or resources they required to support sustained implementation. Interviews were transcribed and thematically analysed using NVivo. Themes were categorised using the Theoretical Domains Framework (TDF). Evidence-based techniques were identified using the behaviour change technique taxonomy to target relevant TDF domains.
Three themes emerged from interviews: anxieties about using a CBA, experiences of implementing a CBA, and sustainability for future implementation of a CBA. Themes crossed multiple TDF domains and indicated concerns with knowledge, beliefs about capabilities and consequences, social and professional roles, social influences, emotion, and environmental context and resources. We identified evidence-based strategies that may support sustainable implementation of a CBA for LBP in a physiotherapy setting.
This study highlighted potential challenges for physiotherapists in the provision of evidence-based LBP care within the current UK NHS. Using the TDF provided the foundation to develop a tailored, evidence-based, implementation intervention to support long term use of a CBA by physiotherapists managing LBP within UK NHS outpatient departments.
我们的目标有两个：（i）描述物理治疗师在完成广泛的在线培训课程（iBeST）后，实施认知行为方法（CBA）来管理下腰痛（LBP）的经验，以及（ii）确定如何增强 iBeST，以在广泛使用之前支持长期实施。
我们对来自英格兰中部、牛津郡和德比郡的六个国民保健服务部门的 11 名物理治疗师进行了半结构化访谈。问题集中在（i）使用 iBeST 来支持实施，（ii）他们在实施过程中遇到的障碍，以及（iii）他们需要哪些信息或资源来支持持续实施。访谈记录被转录并使用 NVivo 进行主题分析。使用理论领域框架（TDF）对主题进行分类。使用行为改变技术分类法确定基于证据的技术，以针对相关 TDF 领域。
访谈中出现了三个主题：对使用 CBA 的焦虑，实施 CBA 的经验，以及未来实施 CBA 的可持续性。主题跨越了多个 TDF 领域，并表明对知识、能力和后果的信念、社会和职业角色、社会影响、情绪以及环境背景和资源存在担忧。我们确定了一些基于证据的策略，这些策略可能支持在物理治疗环境中对 LBP 进行 CBA 的可持续实施。
本研究强调了英国国民保健服务体系中，物理治疗师在提供循证 LBP 护理方面可能面临的挑战。使用 TDF 为开发针对特定人群的、基于证据的实施干预措施提供了基础，以支持英国国民保健服务体系门诊部门的物理治疗师长期使用 CBA 来管理 LBP。
