Implementing specialised vestibular physiotherapy in an emergency department: a process evaluation.

Area of Science:

• Implementation Science
• Physiotherapy
• Vestibular Disorders

Background:

• Dizziness and vertigo symptoms, often from peripheral vestibular disorders like BPPV, frequently lead to emergency department (ED) visits.
• Clinical guidelines advocate for physical assessment and treatment maneuvers for these conditions.
• This study assessed the implementation of specialized vestibular physiotherapy (SPV) in an ED setting from a clinician's viewpoint.

Purpose of the Study:

• To evaluate the process of implementing specialized vestibular physiotherapy (SPV) within an Australian emergency department.
• To understand clinician perspectives on the barriers and facilitators of SPV implementation.
• To inform future strategies for integrating SPV services in acute care settings.

Main Methods:

• A retrospective mixed-methods process evaluation utilizing the i-PARiHS framework.
• Quantitative data collected via the Organisational Readiness for Change Assessment (ORCA), Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) from nine clinicians.
• Qualitative data gathered through focus groups or interviews with seven clinicians.

Main Results:

• Key facilitators included strong relationships with service leaders, champions, and medical staff, alongside perceptions of SPV's acceptability and feasibility.
• The primary barrier identified was insufficient workforce capacity within physiotherapy and multidisciplinary teams to deliver and support the innovation.
• Barriers and facilitators spanned multiple domains of the i-PARiHS implementation framework.

Conclusions:

• Clinician reception to SPV implementation in the ED was generally positive, despite identified challenges.
• Recommendations for successful implementation include fostering stakeholder relationships, establishing a clear shared vision, integrating SPV into organizational processes, and enhancing workforce capacity.
• These strategies are vital for guiding the adoption of SPV services in emergency departments.