Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK.
School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
Age Ageing. 2021 Nov 10;50(6):1961-1970. doi: 10.1093/ageing/afab131.
to explore physiotherapists' perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit.
a qualitative semi-structured interview study of 21 physiotherapists working on orthopaedic wards at seven hospitals with different durations of physiotherapy during a recent audit. Thematic analysis of interviews drawing on Normalisation Process Theory to aid interpretation of findings.
four themes were identified: achieving protocolised and personalised care; patient and carer engagement; multidisciplinary team engagement across the care continuum and strategies for service improvement. Most expressed variation from protocol was legitimate when driven by what is deemed clinically appropriate for a given patient. This tailored approach was deemed essential to optimise patient and carer engagement. Participants reported inconsistent degrees of engagement from the multidisciplinary team attributing this to competing workload priorities, interpreting 'postoperative physiotherapy' as a single professional activity rather than a care delivery approach, plus lack of integration between hospital and community care. All participants recognised changes needed at both structural and process levels to improve their services.
physiotherapists highlighted an inherent conflict between their intention to deliver protocolised care and allowing for an individual patient-tailored approach. This conflict has implications for how audit results should be interpreted, how future clinical guidelines are written and how physiotherapists are trained. Physiotherapists also described additional factors explaining variation in practice, which may be addressed through increased engagement of the multidisciplinary team and resources for additional staffing and advanced clinical roles.
探讨物理治疗师对机制的看法，以解释在全国性审计中观察到髋部骨折手术后早期术后实践中观察到的变异性。
对在最近的审计中接受不同时间物理治疗的七家医院的骨科病房工作的 21 名物理治疗师进行了定性半结构式访谈研究。使用规范化进程理论对访谈进行主题分析，以帮助解释研究结果。
确定了四个主题：实现规范化和个性化护理；患者和照顾者的参与；跨护理连续体的多学科团队参与以及服务改进策略。当以特定患者认为临床合适的标准驱动时，大多数与方案不符的变化都是合理的。这种量身定制的方法对于优化患者和照顾者的参与至关重要。参与者报告说，多学科团队的参与程度不一致，他们将这归因于工作量优先级的竞争，将“术后物理治疗”解释为单一的专业活动，而不是一种护理方法，以及医院和社区护理之间缺乏整合。所有参与者都认识到需要在结构和流程层面进行改进，以改善他们的服务。
物理治疗师强调了他们提供规范化护理的意图与允许个体化患者量身定制方法之间的固有冲突。这种冲突对如何解释审计结果、如何编写未来的临床指南以及如何培训物理治疗师具有影响。物理治疗师还描述了解释实践中变异性的其他因素，通过增加多学科团队的参与以及为额外人员配备和高级临床角色提供资源，这些因素可能会得到解决。
