理解临床实践指南实施中的行为改变：一项定性研究。

Understanding Behavior Change in Clinical Practice Guideline Implementation: A Qualitative Study.

作者信息

Tilson Julie K, Martinez Clarisa, Mickan Sharon, D'Silva Linda J, Howard Robbin, MacDowell Sara, Roth Heidi R, Skop Karen M, Dannenbaum Elizabeth, Farrell Lisa

机构信息

Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California (J.K.T., C.M., and R.H.); Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia (S.M.); Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center Kansas City, Missouri (L.J.D.); Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana (S.M.); Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (H.R.R.); Physical Medicine and Rehabilitation Services, James A. Haley Veterans Hospital, Tampa, Florida and University of South Florida, Morsani College of Medicine, Tampa, Florida (K.M.S.); Jewish Rehabilitation Hospital, CISSS Laval, Laval, Quebec, Canada (E.D.); and Symmetry Alliance, Weston, Florida (L.F.).

出版信息

J Neurol Phys Ther. 2025 Jan 1;49(1):13-23. doi: 10.1097/NPT.0000000000000498. Epub 2024 Oct 15.

DOI:10.1097/NPT.0000000000000498

PMID:39656160

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11594560/

Abstract

BACKGROUND AND PURPOSE

Growing numbers of clinical practice guidelines (CPGs) are available to neurologic physical therapists to guide and inform evidence-based patient care. Adherence to CPG recommendations often necessitates behavior change for therapists and patients. The purpose of this qualitative study was to gain insight into the experiences, perspectives, and drivers of behavioral change for therapists working to improve adherence to a CPG. We also sought to understand the perspectives of patients impacted by this work.

METHODS

Five sites participated in a 6-month implementation study integrating a CPG into local practice using the Knowledge to Action model. At the conclusion of the intervention, therapists and patients were recruited to participate in semi-structured interviews or focus groups. An inductive phenomenological approach was used for data analysis. Two authors coded data to generate primary themes. A secondary analysis used the Capability, Opportunity, Motivation, Behavior (COM-B) model to explain the drivers of behavior change for therapists and patients.

RESULTS

Perspectives from 16 therapists generated 6 themes around feedback/accountability, teamwork/belonging, complexity/adaptability, leadership/prioritization, engagement/benefit, and motivation/growth. Twelve patients' perspectives generated 2 themes around communication/personalization and support/recovery. Drivers for behavior change associated with the COM-B model are highlighted.

DISCUSSION AND CONCLUSIONS

Therapist adherence to CPG recommendations was supported by inclusive and goal-directed teams, regular quantitative audit and feedback, opportunities for learning, and a sense of accountability to their coworkers, patients, and themselves. Patients' engagement in rehabilitation was supported by personalized education, objective measures of progress, and a strong therapeutic relationship.

VIDEO ABSTRACT AVAILABLE

for more insights from the authors (see the video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A491).

摘要

背景与目的

越来越多的临床实践指南可供神经物理治疗师使用，以指导并为循证患者护理提供信息。遵循临床实践指南的建议通常需要治疗师和患者改变行为。这项定性研究的目的是深入了解致力于提高对临床实践指南遵循度的治疗师的经历、观点和行为改变驱动因素。我们还试图了解受这项工作影响的患者的观点。

方法

五个地点参与了一项为期6个月的实施研究，该研究使用知识转化为行动模型将一项临床实践指南纳入当地实践。在干预结束时，招募治疗师和患者参与半结构化访谈或焦点小组。采用归纳现象学方法进行数据分析。两位作者对数据进行编码以生成主要主题。二次分析使用能力、机会、动机、行为（COM-B）模型来解释治疗师和患者行为改变的驱动因素。