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Understanding Behavior Change in Clinical Practice Guideline Implementation: A Qualitative Study.

Julie K Tilson1, Clarisa Martinez, Sharon Mickan

  • 1Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California (J.K.T., C.M., and R.H.); Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia (S.M.); Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center Kansas City, Missouri (L.J.D.); Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana (S.M.); Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (H.R.R.); Physical Medicine and Rehabilitation Services, James A. Haley Veterans Hospital, Tampa, Florida and University of South Florida, Morsani College of Medicine, Tampa, Florida (K.M.S.); Jewish Rehabilitation Hospital, CISSS Laval, Laval, Quebec, Canada (E.D.); and Symmetry Alliance, Weston, Florida (L.F.).

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Summary
This summary is machine-generated.

Improving adherence to neurologic physical therapy clinical practice guidelines (CPGs) requires supportive teams, feedback, and learning opportunities for therapists. Patient engagement is enhanced through personalized education and clear progress indicators.

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Area of Science:

  • Neurologic Physical Therapy
  • Evidence-Based Practice
  • Behavioral Science

Background:

  • Clinical practice guidelines (CPGs) are increasingly available for neurologic physical therapists.
  • Adherence to CPGs often requires significant behavior change for both therapists and patients.
  • Understanding the drivers of this behavior change is crucial for effective implementation.

Purpose of the Study:

  • To explore therapists' experiences and perspectives on adhering to a CPG.
  • To identify the key drivers of behavioral change for therapists implementing CPGs.
  • To understand patients' perspectives on the impact of CPG implementation on their care.

Main Methods:

  • A 6-month implementation study using the Knowledge to Action model across five sites.
  • Semi-structured interviews and focus groups with therapists and patients post-intervention.
  • Inductive phenomenological analysis and secondary analysis using the Capability, Opportunity, Motivation, Behavior (COM-B) model.

Main Results:

  • Therapist themes included feedback, teamwork, complexity, leadership, engagement, and motivation.
  • Patient themes focused on communication, personalization, support, and recovery.
  • The COM-B model highlighted specific drivers for therapist and patient behavior change.

Conclusions:

  • Therapist adherence is fostered by collaborative teams, audit feedback, learning, and accountability.
  • Patient engagement is improved by personalized education, objective progress measures, and strong therapeutic alliances.
  • Successful CPG implementation relies on addressing both provider and patient behavioral factors.