Barriers and facilitators to the use of clinical practice guidelines in osteoarthritis care: a qualitative study among German physiotherapists

Abstract

Objectives The objective of this study was to explore barriers and facilitators to the use of clinical practice guidelines (CPGs) in osteoarthritis (OA) care among German physiotherapists.Design Qualitative semistructured interviews were conducted with German physiotherapists. An interview topic guide based on the Theoretical Domains Framework (TDF) was developed to explore perceived barriers and facilitators to the use of CPGs in OA care. Interviews were audio-recorded and transcribed verbatim. In a first step, the data were coded inductively using thematic analysis. Subsequently, the emerged themes were deductively reassigned to the relevant domains of the TDF and categorised as barriers and facilitators.Setting Outpatient physiotherapy practices in Germany.Participants Physiotherapists working in an outpatient setting in Germany and involved in the management of patients with hip and knee OA were eligible to participate.Results Eleven physiotherapists (7 women, 4 men) were interviewed between February and September 2023. The mean age was 34.2 years (± 9.9, range 23–57). Most factors influencing guideline-recommended care were identified in the TDF domains ‘knowledge’, ‘beliefs about consequences’, ‘environmental context and resources’ and ‘social influences’. For example, physiotherapists perceived low awareness of existing CPGs, loss of individuality in treatment, time constraints and dissonant patient expectations as barriers to the use of CPGs. Discussion of guideline recommendations within the team and the expectation of improved patient outcomes and resource savings were reported as facilitators.Conclusions Multiple factors were identified that were perceived to influence clinical practice in Germany. The results of this study can inform the development of theory-based interventions aimed at changing physiotherapists’ behaviour to support them in providing optimal OA care.Trial registration German Clinical Trials Register (DRKS00030800). Registered 12 December 2022.