Health practitioners’ perceptions of adopting clinical prediction rules in the management of musculoskeletal pain: a qualitative study in Australia

Abstract

ObjectivesTo investigate health practitioners’ understanding and practice behaviours with regards to clinical prediction rules (CPRs) and explore their perceptions of adopting a new whiplash CPR.DesignQualitative study using six semistructured focus groups.SettingPrimary and secondary care in New South Wales and Queensland, Australia.ParticipantsPhysiotherapists (n=19), chiropractors (n=6) and osteopaths (n=3) were purposively sampled to include health practitioners who provide routine treatment to people with whiplash-associated disorders.MethodsFocus group discussions (n=6) were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach.ResultsHealth practitioners’ understanding and use of CPRs were mixed. Clinicians considered components relating to acceptability (‘whether I agree with it’) and implementation (‘how I'll use it’) when deciding on whether to adopt a new CPR. Acceptability was informed by four themes: knowledge and understanding, CPR type, congruence and weighted value. Consideration of matters that promote implementation occurred once a CPR was deemed to be acceptable. Three themes were identified as potentially enhancing whiplash CPR implementation: the presence of an external driver of adoption, flexibility in how the CPR could be administered and guidance regarding communication of CPR output to patients.ConclusionsEducation on CPR purpose and fit with practice is needed to enhance the perceived acceptability of CPRs. Strategies that facilitate practitioner motivation, enable administrative flexibility and assist clinicians in communicating the results of the whiplash CPR could promote adoption of the whiplash CPR.

Methodological standards for the development and evaluation of clinical prediction rules: a review of the literature

“…The validated Ottawa Acceptability of Decision Rules survey instrument can be used both to measure the overall acceptability of a CPR, and to assess specific barriers to its use, which can inform potential improvements to the CPR as well as the design of dedicated implementation strategies [48]. Qualitative studies can be invaluable for determining the acceptability of a CPR but are relatively rare [200, 220, 222–225].…”

“…Clearly, identifying the barriers and facilitators to the implementation of CPRs is crucial for the development of targeted implementation strategies that may encourage clinicians to use the CPR. The adoption of CPRs into clinical practice is influenced by various factors including clinician characteristics, patient factors, features of the CPR itself and environmental factors [32, 66, 221, 224, 225, 240–252].…”

“…Table 4 provides an overview of the barriers to the adoption of CPRs identified in the literature [253], grouped according to their effect on clinician knowledge, attitudes or behaviours [254]. Barriers relating to knowledge include lack of awareness of the CPR or the burden of the clinical problem it applies to, unfamiliarity with the CPR and a lack of understanding of the purpose of CPRs in general [225, 240–242]. Clinicians may also be unaware of a CPR due to the increasing volume of CPRs, particularly when they are developed for the same condition [61, 243].…”

“…Complex models such as those based on machine and artificial learning algorithms may introduce additional barriers relating to applicability and usability, due to their potential lack of reproducibility and transparency [60, 82]. Other studies have demonstrated that clinicians will be unlikely to use a CPR if there are predictors missing which are deemed to be important, or if the predictor variables are not logically related to the outcome variable [32, 225]. Reilly and Evans [32] offer a number of strategies for overcoming barriers to the use of CPRs.…”

Best Evidence Rehabilitation for Chronic Pain Part 4: Neck Pain

“…There are several tools available to achieve this—WhipPredict for patients with WAD, the short-form Orebro Musculoskeletal screen for WAD and non-traumatic neck pain, and StartMSK for non-traumatic neck pain (see Table 2 for availability). Research suggests that rehabilitation health care providers are not aware of prognostic indicators and do not use clinical risk screening tools for patients with neck pain [71,72]. The majority of patients will fall into the ‘low risk’ category; in other words, they should recover well with minimal treatment comprising a few sessions of advice, reassurance, and exercise.…”