Department of Sports Science and Clinical Biomechanics, University of Southern Denmark.
Nordic Institute of Chiropractic and Clinical Biomechanics, Odense M, Denmark.
JBI Evid Implement. 2021 May 10;19(4):394-408. doi: 10.1097/XEB.0000000000000284.
Guidelines for low back pain (LBP) management recommend patient education and exercises. GLA:D Back, a structured group-based patient-education exercise program for LBP, facilitates evidence-based care implementation. This study aimed to inform on the implementation processes, assessing clinician-related factors. Objectives were to describe profiles of implementers and nonimplementers by demographics, and responses to the tailored version of the Determinants of Implementation Behaviour Questionnaire (DIBQ-t) qualitatively explore clinician perspectives on implementation, and compare the results of the DIBQ-t with the interview data to evaluate their fit of integration for facilitators, barriers, and new insights.
A mixed-methods parallel design study was conducted. Physiotherapists and chiropractors, educated in the GLA:D Back program, were asked to complete the DIBQ-t (measuring theoretical determinants of implementation) 6 months after their training. Implementers and nonimplementers of the program were selected for interviews. Qualitative data were used to understand clinicians' viewpoints on implementation, providing a broader perspective on the quantitative data and exploring new aspects.
More physiotherapists than chiropractors implemented the program. Implementers responded more positively on most domains of the DIBQ-t. The interviews revealed three themes important for implementation: personal gain, practicalities, and buying-in on the program. Clinicians' attitudes to the program appeared additionally as relevant to implementation.
The profession of the clinician was associated with implementation behavior. Implementers and nonimplementers identified the same themes but perceived them as either positive or negative. Both groups reported high levels of knowledge and skills, indicating that training alone is insufficient for implementation.
腰椎疾病（LBP）管理指南建议进行患者教育和锻炼。GLA:D Back 是一种针对 LBP 的结构化团体基础患者教育锻炼计划，有助于实施基于证据的护理。本研究旨在了解实施过程，评估与临床医生相关的因素。目的是通过人口统计学描述实施者和非实施者的特征，并通过定性分析来探讨临床医生对实施的看法，以及比较实施者行为问卷（DIBQ-t）的结果与访谈数据，以评估其对促进因素、障碍和新见解的整合程度。
本研究采用混合方法平行设计。接受过 GLA:D Back 培训的物理治疗师和脊医被要求在培训后 6 个月完成 DIBQ-t（测量实施的理论决定因素）。选择该计划的实施者和非实施者进行访谈。定性数据用于了解临床医生对实施的观点，为定量数据提供更广泛的视角，并探索新的方面。
实施该计划的物理治疗师多于脊医。实施者在 DIBQ-t 的大多数领域的反应更为积极。访谈揭示了实施的三个重要主题：个人收益、实际情况和对计划的认同。临床医生对该计划的态度似乎也与实施相关。
临床医生的专业与实施行为相关。实施者和非实施者确定了相同的主题，但对其看法是积极的还是消极的。两组都报告了高水平的知识和技能，这表明仅培训不足以实施。
