School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland.
Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland.
Rheumatol Int. 2024 Jun;44(6):1035-1050. doi: 10.1007/s00296-024-05590-9. Epub 2024 Apr 22.
Targeted efforts to better understand the barriers and facilitators of stakeholders and healthcare settings to implementation of exercise and education self-management programmes for osteoarthritis (OA) are needed. This study aimed to explore the barriers and facilitators to the implementation of Good Life with osteoArthritis in Denmark (GLA:D), a supervised group guideline-based OA programme, across Irish public and private healthcare settings. Interviews with 10 physiotherapists (PTs; 8 public) and 9 people with hip and knee OA (PwOA; 4 public) were coded by the Consolidated Framework for Implementation Research (CFIR) constructs in a case memo (summary, rationale, quotes). The strong positive/negative implementation determinants were identified collaboratively by rating the valence and strength of CFIR constructs on implementation. Across public and private settings, PTs and PwOA strongly perceived GLA:D Ireland as evidence-based, with easily accessible education and modifiable marketing/training materials that meet participants' needs, improve skills/confidence and address exercise beliefs/expectations. Despite difficulties in scheduling sessions (e.g., work/caring responsibilities), PTs in public and private settings perceived advantages to implementation over current clinical practice (e.g., shortens waiting lists). Only PTs in public settings reported limited availability of internal/external funding, inappropriate space, marketing/training tools, and inadequate staffing. Across public and private settings, PwOA reported adaptability, appropriate space/equipment and coaching/supervision, autonomy, and social support as facilitators. Flexible training and tailored education for stakeholders and healthcare settings on guideline-based OA management may promote implementation. Additional support on organising (e.g., scheduling clinical time), planning (e.g., securing appropriate space, marketing/training tools), and funding (e.g., accessing dedicated internal/external grants) may strengthen implementation across public settings.
需要有针对性地努力，以更好地了解利益相关者和医疗保健环境在实施骨关节炎（OA）运动和教育自我管理计划方面的障碍和促进因素。本研究旨在探讨在爱尔兰公共和私人医疗保健环境中实施基于监督小组指南的 OA 方案——丹麦骨性关节炎美好生活（GLA:D）的障碍和促进因素。对 10 名物理治疗师（PT；8 名来自公共部门）和 9 名髋和膝关节 OA 患者（PwOA；4 名来自公共部门）进行了访谈，并根据实施综合框架（CFIR）结构对访谈内容进行了编码（总结、基本原理、引述）。通过对 CFIR 结构实施的重要性和强度进行评级，共同确定了实施的强烈积极/消极决定因素。在公共和私人部门中，PT 和 PwOA 都强烈认为 GLA:D Ireland 具有循证依据，具有易于获取的教育和可修改的营销/培训材料，满足参与者的需求，提高技能/信心，并解决运动信念/期望。尽管在安排课程方面存在困难（例如工作/照顾责任），但公共和私人部门的 PT 认为实施相对于当前的临床实践具有优势（例如，缩短了等候名单）。只有公共部门的 PT 报告内部/外部资金有限、空间不合适、营销/培训工具不足以及人员配备不足。在公共和私人部门中，PwOA 报告了适应性、适当的空间/设备、辅导/监督、自主性和社会支持等促进因素。针对利益相关者和医疗保健环境提供基于指南的 OA 管理培训和量身定制的教育，可能会促进实施。在组织（例如安排临床时间）、计划（例如确保适当的空间、营销/培训工具）和资金（例如获取专用的内部/外部赠款）方面为公共部门提供额外支持，可能会加强实施力度。
