School of Health Sciences, Institute of Physiotherapy, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8400, Switzerland.
BMC Health Serv Res. 2023 Sep 27;23(1):1034. doi: 10.1186/s12913-023-10023-7.
The guideline-based, conservative, non-pharmacological management of hip and knee osteoarthritis in clinical practice has been insufficient in Switzerland until now. The implementation of "Good Life with Osteoarthritis in Denmark" (GLA:D®), a programme designed to address this evidence-performance gap, was started in 2019 in Switzerland. This study investigated the acceptance and practicality of the GLA:D® Switzerland programme and identified the facilitators and barriers to its implementation, to support the development of tailored implementation strategies.
This is a non-experimental observational study. A cross-sectional survey was performed among the physiotherapists (PTs) of the first five GLA:D® Switzerland certification courses, using the Measurement Instrument for Determinants of Innovations (MIDI) to identify the facilitators and barriers. Descriptive statistics were calculated, and qualitative content analysis was used for open-ended questions.
In the online survey, 86 GLA:D® certified PTs participated (response rate: 61%). The majority of 51 PTs (63.7%) worked in private practices. Of the responding PTs 58 (78.4%) were satisfied with the general concept of the GLA:D® Switzerland programme. Practicality was evaluated positively, particularly the second and third individual session (n = 40 PTs, 83.3%), the 40 m Fast-paced Walk Test (43, 89.6%), the 30 s Chair Stand Test (45, 93.8%), and the exercise programme (40, 83.3%). The marketing (12, 15%), the 'data entry' (5, 10.4%), 'register the patient' (7, 14.6%), and the digital patient questionnaire (9, 14.2%) were rated less positively. In total, 12 facilitators and 12 barriers were identified. The barriers were mainly related to adopting user, e.g., perceived personal disadvantages. Barriers were also found in the organisational context, e.g., time available. Facilitators were associated with the GLA:D® Switzerland programme itself, e.g., completeness, relevance for patients, and the adopting user, e.g., self-efficacy, and in the organisational context, e.g., material resources and facilities. Topics related to the socio-political context were raised in the answers to the open-ended questions, e.g., general awareness level of the GLA:D® Switzerland programme and patient recruitment.
The acceptance, practicality and facilitators identified from the initial implementation are encouraging. However, the identified barriers and activities rated with low practicality require tailored strategies to support a successful implementation of the GLA:D® Switzerland programme.
直到现在，瑞士的髋膝关节骨关节炎临床实践一直以基于指南的、保守的、非药物治疗为主，但这种方法并不完善。丹麦“骨关节炎的美好生活”（GLA:D®）项目旨在解决这一证据与实践之间的差距，自 2019 年以来已在瑞士启动。本研究旨在调查 GLA:D®瑞士项目的接受程度和实用性，并确定其实施的促进因素和障碍，以支持制定量身定制的实施策略。
这是一项非实验性观察研究。对前五个 GLA:D®瑞士认证课程的物理治疗师（PT）进行了横断面调查，使用创新测量工具（MIDI）来确定促进因素和障碍。计算了描述性统计数据，并对开放性问题进行了定性内容分析。
在在线调查中，有 86 名 GLA:D®认证的 PT 参与（应答率：61%）。51 名 PT 中有 51 名（63.7%）在私人诊所工作。86 名 PT 中有 58 名（78.4%）对 GLA:D®瑞士项目的总体概念表示满意。实用性评价较高，特别是第二和第三次个体课程（n=40，83.3%）、40m 快速步伐行走测试（43，89.6%）、30s 椅式站立测试（45，93.8%）和运动方案（40，83.3%）。市场营销（12，15%）、“数据输入”（5，10.4%）、“登记患者”（7，14.6%）和数字患者问卷（9，14.2%）的评价较低。共有 12 个促进因素和 12 个障碍。障碍主要与采用者有关，例如，感知到的个人劣势。在组织环境中也发现了障碍，例如，可用时间。促进因素与 GLA:D®瑞士项目本身有关，例如，完整性、对患者的相关性，以及采用者，例如，自我效能感，以及在组织环境中，例如，物质资源和设施。在开放性问题的回答中提出了与社会政治环境有关的话题，例如，对 GLA:D®瑞士项目的普遍认识水平和患者招募。
从初步实施中确定的接受程度、实用性和促进因素令人鼓舞。然而，确定的障碍和实用性较低的活动需要制定有针对性的策略，以支持 GLA:D®瑞士项目的成功实施。
