Barriers to the implementation of point-of-care ultrasonography by physiotherapists in haemophilia treatment centres in Canada: a modified Delphi approach

Strike, Karen; Chan, Anthony; Maly, Monica R.; Solomon, Patricia

doi:10.17225/jhp00146

Figures & Tables

Physiotherapist-performed point-of-care ultrasonography (POC-US) can help to provide more sensitive physical examinations in haemophilia care; however, it is not yet routinely used for this purpose. Identifying barriers to its implementation is an important first step towards improving the physical examination of haemophilia patients.© Shutterstock

Knowledge-to-Action (KTA) Framework [23]The KTA Framework shown here has been modified to conceptualise the gap regarding the implementation of physiotherapyperformed POC-US. Text in the green ovals indicates current knowledge in the field of POC-US and the work to date on training and implementation of the tool. The turquoise star indicates the focus of this study at the level of barriers to knowledge use.

Consolidated Framework for Implementation Research (CFIR) [24,25]The areas highlighted with blue ovals highlight the three constructs investigated in this study within the CFIR to identify and achieve a consensus on the barriers and facilitators to the implementation of physiotherapy-performed POC-US in haemophilia care.

Results from Delphi Round 3

					SCORE 3
MBS			25TH	75TH	OR 4 ON
ITEM	N	MEDIAN	%ILE	%ILE	MBS (%)
Q1	20	1.0	1.0	2.0	5
Q2	20	1.0	1.0	2.0	14
Q3	20	1.0	1.0	2.0	10
Q4	20	1.0	1.0	1.0	0
Q5	21	1.0	1.0	2.0	19
Q6	21	2.0	1.0	3.0	34
Q7	21	4.0	3.0	4.0	81
Q8	16	1.0	1.0	2.0	0
Q9	20	1.0	1.0	2.0	14
Q10	19	1.0	1.0	1.0	0
Q11	16	1.0	1.0	2.0	0
Q12	18	2.0	1.0	2.0	10
Q13	21	2.0	1.0	3.0	43
Q14	17	1.0	1.0	1.0	0
Q15	Consensus achieved in Round #2
Q16	21	1.0	1.0	1.0	0
Q17	17	1.0	1.0	2.0	5
Q18	20	1.0	1.0	2.0	10
Q19	20	4.0	3.0	4.0	86
Q20	21	1.0	1.0	1.0	0
Q21	20	1.0	1.0	2.0	10
Q22	18	1.0	1.0	1.0	0
Q23	17	1.0	1.0	2.0	5
Q24	19	1.0	1.0	2.0	0
Q25	20	1.0	1.0	2.0	19
Q26	21	1.0	1.0	1.0	5
Q27	18	1.0	1.0	2.0	10
Q28	21	2.0	1.0	2.0	15
Q29	Consensus achieved in Round #2

Results from Delphi Round 2

					SCORE 3
MBS			25TH	75TH	OR 4 ON
ITEM	N	MEDIAN	%ILE	%ILE	MBS (%)
Q1	21	1.0	1.0	2.0	10
Q2	21	1.0	1.0	2.0	15
Q3	20	2.0	1.0	2.0	10
Q4	19	1.0	1.0	1.0	0
Q5	21	1.0	1.0	2.0	19
Q6	21	2.0	2.0	3.0	48
Q7	21	3.0	2.0	4.0	71
Q8	18	1.0	1.0	2.0	10
Q9	20	1.0	1.0	2.0	10
Q10	18	1.0	1.0	1.0	0
Q11	16	1.0	1.0	2.0	5
Q12	18	2.0	1.0	2.0	10
Q13	21	3.0	2.0	4.0	62
Q14	18	1.0	1.0	2.0	0
Q15	21	4.0	3.0	4.0	76
Q16	20	1.0	1.0	1.5	10
Q17	19	1.0	1.0	2.0	10
Q18	20	1.0	1.0	2.0	10
Q19	21	3.0	3.0	4.0	76
Q20	21	1.0	1.0	1.0	0
Q21	20	1.0	1.0	2.0	0
Q22	19	1.0	1.0	1.0	5
Q23	14	1.0	1.0	2.0	10
Q24	16	1.0	1.0	1.5	5
Q25	20	2.0	1.0	3.0	28
Q26	21	1.0	1.0	1.0	0
Q27	18	1.0	1.0	2.0	10
Q28	21	1.0	1.0	2.0	24
Q29	21	4.0	2.0	4.0	71

Results from Delphi Round 1

					SCORE 3
MBS			25TH	75TH	OR 4 ON
ITEM	N	MEDIAN	%ILE	%ILE	MBS (%)
Q1	18	1.5	1.0	2.0	20
Q2	17	1.0	1.0	2.0	10
Q3	16	2.0	1.0	2.0	15
Q4	19	1.0	1.0	2.0	5
Q5	20	1.0	1.0	2.0	20
Q6	20	2.0	1.0	3.0	30
Q7	20	2.0	1.5	3.0	40
Q8	16	2.0	1.5	2.0	15
Q9	19	1.0	1.0	2.0	20
Q10	18	1.0	1.0	2.0	0
Q11	11	2.0	1.0	2.0	5
Q12	14	2.5	1.0	3.0	35
Q13	20	2.5	1.0	3.0	50
Q14	16	1.0	1.0	2.0	5
Q15	20	3.0	2.0	4.0	55
Q16	20	1.0	1.0	2.0	5
Q17	14	1.0	1.0	2.0	10
Q18	18	1.0	1.0	1.0	10
Q19	19	2.0	1.0	3.0	45
Q20	19	1.0	1.0	1.0	0
Q21	19	2.0	1.0	2.0	10
Q22	15	1.0	1.0	2.0	5
Q23	12	2.0	1.0	2.0	10
Q24	13	2.0	1.0	2.0	5
Q25	17	1.0	1.0	2.0	20
Q26	20	1.0	1.0	1.0	5
Q27	14	1.0	1.0	2.0	0
Q28	20	2.0	1.0	3.0	30
Q29	20	3.0	2.0	4.0	60

Instructions: We would like to know the extent to which you think each of the following situations is a barrier to physiotherapists’ (PT) use of research related to Point-of-Care Ultrasonography and the ability to use this research in support of implementation of the tool (POC-US) to alter/enhance clinical practice_ For each item, circle the number of the response that best represents your view_ Thank you for sharing your views with us_

	THIS IS A BARRIER
	TO NOEXTENT	TO ALITTLEEXTENT	TO AMODERATEEXTENT	TO AGREATEXTENT	NOOPINION
1. Research reports/articles are not readily available at my HTC	1	2	3	4	5
2. Implications for practice are not made clear	1	2	3	4	5
3. Statistical analyses are not understandable	1	2	3	4	5
4. The research is not relevant to the PT’s practice in the HTC	1	2	3	4	5
5. The PT is unaware of the research	1	2	3	4	5
6. The HTC facilities are inadequate for implementation	1	2	3	4	5
7. The PT does not have time to read research related to POC-US	1	2	3	4	5
8. The research in POC-US has not been replicated	1	2	3	4	5
9. The PT feels the benefits of changing practice will be minimal	1	2	3	4	5
10. The PT is uncertain whether to believe the results of the research	1	2	3	4	5
11. The research in POC-US has methodological inadequacies	1	2	3	4	5
12. The relevant literature is not compiled in one place	1	2	3	4	5
13. The PT does not feel he/she has enough authority to change patient care procedures	1	2	3	4	5
14. The PT feels the literature is not generalizable to their HTC	1	2	3	4	5
15. The PT is isolated from knowledgeable colleagues with whom to discuss POC-US	1	2	3	4	5
16. The PT sees little benefit for self	1	2	3	4	5
17. Research reports/articles in POC-US are not published fast enough	1	2	3	4	5
18. Hematologists will not cooperate with POC-US implementation	1	2	3	4	5
19. Administration will not allow POC-US implementation	1	2	3	4	5
20. The PT does not see the value of research and POC-US in the HTC	1	2	3	4	5
21. There is not a documented need to change practice	1	2	3	4	5
22. The conclusions drawn from the research are not justified	1	2	3	4	5
23. The literature in POC-US reports conflicting results	1	2	3	4	5
24. The research in POC-US is not reported clearly and readably	1	2	3	4	5
25. Other staff are not supportive of POC-US implementation	1	2	3	4	5
26. The PT is unwilling to change/try new ideas	1	2	3	4	5
27. The amount of research in POC-US is overwhelming	1	2	3	4	5
28. The PT does not feel capable of evaluating the quality of the research in POC-US	1	2	3	4	5
29. There is insufficient time on the job to implement new ideas	1	2	3	4	5

j_jhp00146_tab_005_w2aab3b7c52b1b6b1ab2b2b1b8Aa

	TO NOEXTENT	TO ALITTLEEXTENT	TO AMODERATEEXTENT	TO AGREATEXTENT	NOOPINION
30.
31.
32.
33.
34.

Barriers to the implementation of point-of-care ultrasonography by physiotherapists in haemophilia treatment centres in Canada: a modified Delphi approach

Figures & Tables

Figure 1

Figure 2

Results from Delphi Round 3

Results from Delphi Round 2

Results from Delphi Round 1

j_jhp00146_tab_005_w2aab3b7c52b1b6b1ab2b2b1b8Aa

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