Lowry Véronique, Desmeules François, Lavigne Patrick, Décary Simon, Tousignant-Laflamme Yannick, Martel Marylie, Roy Jean-Sébastien, Perreault Kadija, Lefebvre Marie-Claude, Kilpatrick Kelley, Hudon Anne, Zidarov Diana
School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec H3N 1X7, Canada.
Centre de recherche de l'Hôpital Maisonneuve-Rosemont (CR-HMR), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal, Montréal, Québec H1T 2M4, Canada.
Phys Ther. 2025 Jan 8;105(1). doi: 10.1093/ptj/pzae160.
Suboptimal primary health care management of shoulder pain has been reported in previous studies. Implementing clinical practice guidelines (CPGs) recommendations using a theoretical approach is recommended to improve shoulder pain management. This study aims to identify determinants of implementing recommendations from shoulder CPGs to help develop an intervention based on the identified determinants.
Family physicians and physical therapists managing patients with shoulder pain in primary care were invited to participate in a qualitative study to identify determinants to implementing recommendations from shoulder CPGs. The Theoretical Domains Framework (TDF) was used to inform the creation of the semi-structured interview guide and for deductive coding of transcriptions. The determinants were mapped to intervention functions and behavior change techniques (BCT) using the Behavior Change Wheel method and strategies for implementing CPGs recommendations were identified.
Interviews were conducted with 16 family physicians and 19 physical therapists. We identified 12 barriers and 6 facilitators within 7 TDF domains: knowledge, skills, beliefs about capabilities, beliefs about consequences, intentions, environmental context and resources, and social influence. We identified 6 intervention functions and 12 BCT addressing the relevant determinants. The 11 implementation strategies identified include the development and distribution of educational material, interactive educational outreach visits, and audit and feedback. Other components to consider are the identification and preparation of champions in primary care clinical settings, revision of professional roles, and creation of interdisciplinary clinical teams.
The identification of barriers and facilitators to implementing recommendations from shoulder CPGs allowed us to select implementation strategies at individual and organizational levels.
The implementation strategies will be adapted to specific primary care contexts in consultation with stakeholders and operationalized into a multicomponent implementation intervention. Implementing the intervention has the potential to improve shoulder pain management in primary care and facilitate the use of evidence-based recommendations from CPGs.
既往研究报道了肩痛的初级卫生保健管理未达最佳状态。建议采用理论方法实施临床实践指南（CPG）建议，以改善肩痛管理。本研究旨在确定实施肩部CPG建议的决定因素，以帮助基于所确定的决定因素制定干预措施。
邀请在初级保健中管理肩痛患者的家庭医生和物理治疗师参与一项定性研究，以确定实施肩部CPG建议的决定因素。理论域框架（TDF）用于指导半结构化访谈指南的创建以及转录本的演绎编码。使用行为改变轮方法将决定因素映射到干预功能和行为改变技术（BCT），并确定实施CPG建议的策略。
对16名家庭医生和19名物理治疗师进行了访谈。我们在7个TDF领域中确定了12个障碍和6个促进因素：知识、技能、对能力的信念、对后果的信念、意图、环境背景和资源以及社会影响。我们确定了6种干预功能和12种BCT来解决相关决定因素。确定的11种实施策略包括教育材料的开发和分发、互动式教育外展访问以及审核和反馈。其他需要考虑的组成部分包括在初级保健临床环境中识别和培养倡导者、修订专业角色以及创建跨学科临床团队。
确定实施肩部CPG建议的障碍和促进因素使我们能够在个人和组织层面选择实施策略。
实施策略将与利益相关者协商后适用于特定的初级保健环境，并转化为多成分实施干预措施。实施该干预措施有可能改善初级保健中的肩痛管理，并促进使用CPG中的循证建议。
