Current physical therapy practice and implementation factors regarding the evidence-based ‘Rehabilitation of Mobility after Stroke (ReMoS)’ guideline in Germany: a cross-sectional online survey

Scheffler, Bettina; Schimböck, Florian; Schöler, Almut; Rösner, Katrin; Spallek, Jacob; Kopkow, Christian

doi:10.1186/s12883-022-02780-5

Cited by 4 publications

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“…Less than half of the respondents (212/430, 49.3%) were aware of an OA guideline. This is comparable to the results of other surveys among German physiotherapists, where only 29% were aware of a CPG for low back pain [ 32 ] and 52.9% were aware of a CPG for stroke management [ 33 ]. As there is a significant association between guideline awareness and the choice of physiotherapy interventions, improved implementation strategies appear reasonable.…”

Section: Discussionsupporting

confidence: 86%

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Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

Bahns

Kopkow

2023

BMC Musculoskelet Disord

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Background Osteoarthritis (OA) of the hip and the knee is common and leads to pain, stiffness and disability. Clinical practice guidelines (CPG) provide recommendations to assist healthcare professionals in clinical decision-making. Although evidence-based physiotherapy has been shown to be effective in the management OA, a gap between clinical practice and guideline recommendations exists. Little is known about OA management provided by physiotherapists in Germany and whether treatment aligns with CPGs. The objectives of this study were (1) to investigate the current physiotherapy practice in patients with hip and/or knee OA in Germany, (2) to evaluate physiotherapists’ adherence to guideline recommendations and (3) to explore barriers and facilitators to guideline use. Methods A cross-sectional online survey was conducted among physiotherapists. The questionnaire collected information on demographic characteristics, physiotherapists’ management of hip and knee OA and the use of CPGs in clinical practice. Guideline adherence was evaluated by comparing the survey findings with guideline recommendations. Full adherence was assumed if all recommended treatment options were chosen. Results In total, 447 (74.9%) of 597 eligible physiotherapists completed the survey. Data from 442 participants (mean age 41.2 ± 12.8 years; 288 female (65.1%)) were included in the analysis. The most common treatment choices for both hip and knee OA were exercise therapy (hip OA: 424/442, 95.9%; knee OA: 426/442, 96.4%), self-management advice (hip OA: 413/442, 93.2%; knee OA: 395/442, 89.4%) and education (hip OA: 325/442, 73.5%; knee OA: 331/442, 74.9%), followed by manual therapy (hip OA: 311/442, 70.4%; knee OA: 311/442, 70.4%) and joint traction (hip OA: 208/442, 47.1%; knee OA: 199/442, 45.0%). Full guideline adherence was found in 17.2% (76/442) of physiotherapists for hip OA management and in 8.6% (38/442) for knee OA. Less than half of the respondents (212/430, 49.3%) were aware of an OA guideline. Conclusions In accordance with current guideline recommendations, most physiotherapists provide exercise therapy and education for patients with hip and/or knee OA. Interventions with low or conflicting evidence were also frequently provided. The limited awareness of existing OA guidelines and the low guideline adherence indicate an insufficient implementation of CPGs in German physiotherapy practice. Trial registration German Clinical Trials Register (DRKS00026702). Registered 14 October 2021.

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Section: Discussionsupporting

confidence: 86%

“…Lack of time, patients’ preferences, lack of generalisability of research findings to individual patients and lack of support in the workplace are barriers to guideline use mentioned in literature [ 28 – 31 ]. Furthermore, often physiotherapists are not even aware of current CPGs [ 32 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

Bahns

Kopkow

2023

BMC Musculoskelet Disord

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“…In a recent nationwide survey on physiotherapy management of low back pain, less than one-third of the participating physiotherapists reported being aware of the National Disease Management Guideline for "non-specific low back pain" or have dealt with its recommendations [20]. Similar results were shown by another survey, in which only 47% of the responding physiotherapists reported being aware of the German guidelines on stroke rehabilitation [61]. One reason for the low awareness of CPGs could be that the entry level for German physiotherapists is vocational school education.…”

Section: Overviewmentioning

confidence: 58%

Guideline-Adherent Physiotherapy for Patients With Hip and Knee Osteoarthritis in Germany: Protocol for an Implementation Research Project Using the Theoretical Domains Framework and the Behavior Change Wheel

Bahns¹,

Scheffler²,

Kopkow³

2023

JMIR Res Protoc

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Background Hip and knee osteoarthritis is common and leads to pain, stiffness, and disability. Clinical practice guidelines provide recommendations based on the best available evidence to assist health care professionals and patients in clinical decision-making. However, several studies have reported a gap between guideline recommendations and clinical practice in physiotherapy. Improved implementation strategies and the removal of existing barriers may facilitate the transfer of evidence into clinical practice and contribute to optimized quality of care. Objective This paper presents the protocol for a study that aims to describe the current physiotherapy practice in patients with hip and knee osteoarthritis and to investigate physiotherapists’ adherence to clinical practice guidelines, to identify and specify barriers to and facilitators of guideline use and implementation, and to develop and pilot test a theory-based tailored implementation intervention aiming to increase guideline use in osteoarthritis care. Methods The research project is divided into 4 parts. During the first part, we will conduct a nationwide web-based survey among German physiotherapists to evaluate the current management of hip and knee osteoarthritis and to evaluate whether treatment aligns with guideline recommendations. Subsequently, semistructured interviews will be conducted to specify barriers to and facilitators of guideline use and implementation among physiotherapists (part 2). On the basis of these findings, in part 3, we will develop a theory-driven implementation intervention based on the Theoretical Domains Framework and the Behavior Change Wheel, which will be evaluated in a controlled pilot study in terms of effectiveness, feasibility, and acceptability (part 4). Results Data collection of the web-based survey among German physiotherapists (part 1) was completed in December 2021. The semistructured interviews (part 2) were conducted between January and September 2023. Recruitment of physiotherapy practices to participate in the development of the implementation intervention is expected to start in January 2024. Conclusions This research project aims to develop a theory-driven implementation intervention to facilitate the transfer of evidence from hip and knee osteoarthritis guidelines in physiotherapy practice. We hypothesize that successful implementation will lead to increased guideline adherence in physiotherapists, which in turn will improve the quality of care. The results from our project will provide valuable knowledge concerning the development process and effectiveness of tailored implementation interventions. International Registered Report Identifier (IRRID) DERR1-10.2196/47834

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“…Leider hat diese Leitlinie auch 8 Jahre nach ihrer Veröffentlichung nur teilweise Eingang in die therapeutische Praxis gefunden, was erstaunlich und auch etwas ärgerlich erscheint. In einer Untersuchung von Scheffler und Mitarbeitern [23]…”

Section: Umsetzung In Den Alltagunclassified

Rehabilitation/Therapie der Mobilität nach Schlaganfall (ReMoS/TheMoS)

Dohle,

Saal

2024

neuroreha

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Die Arbeitsgruppe „ReMoS“ (Rehabilitation der Mobilität nach Schlaganfall) trägt die Evidenz von Therapieverfahren zur Verbesserung der Mobilität nach Schlaganfall zusammen. Dabei zeichnet sich ab, dass spezifische und intensive Therapiemaßnahmen die Mobilität verbessern können. Welche Empfehlungen leiten sich daraus ab und wie sind sie praktisch umsetzbar?

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Current physical therapy practice and implementation factors regarding the evidence-based ‘Rehabilitation of Mobility after Stroke (ReMoS)’ guideline in Germany: a cross-sectional online survey

Cited by 4 publications

References 67 publications

Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

Guideline-Adherent Physiotherapy for Patients With Hip and Knee Osteoarthritis in Germany: Protocol for an Implementation Research Project Using the Theoretical Domains Framework and the Behavior Change Wheel

Rehabilitation/Therapie der Mobilität nach Schlaganfall (ReMoS/TheMoS)

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