Quality-Based Procedures for Knee Replacement, Hip Replacement, and Hip Fracture: Physiotherapists' Perceptions of Adherence, Barriers, and Facilitators.

Abstract

Purpose: This mixed-methods study examined the perceived barriers to and facilitators of implementing best-practice guidelines (BPGs) and adhering to provincial Quality-Based Procedures (QBPs) by Ontario physiotherapists working with patients after total knee replacement (TKR), total hip replacement (THR), and hip fracture (HF). Method: Using snowball sampling, 93 hospital and home care physiotherapists working with patients after TKR, THR, or HF completed a Web-based survey. A subset of these participated in follow-up semi-structured telephone interviews. Results: The perception of QBP adherence varied, with self-reported adherence rates across identified practice standards for TKR, THR, and HF reported as 62%, 69%, and 60%, respectively. Physiotherapists generally believed that BPGs improved outcomes; however, they identified clinical experience as their primary guide to practice. Only 66% perceived that their institutions met provincial standards. Barriers to BPG implementation and QBP adherence included insufficient time, lack of access to QBPs, and limited awareness of current BPGs. Qualitative themes included awareness and knowledge, flexibility and funding, communication, and availability of and equitable access to outpatient and community-based physiotherapy services. Conclusions: Physiotherapists reported that they primarily used clinical experience to inform care after TKR, THR, and HF, but they were also supportive of BPGs and QBPs. The results suggest that increased access to and education about QBPs, as well as supportive resources, could increase their integration into clinical practice.