Barriers to the implementation of point-of-care ultrasonography by physiotherapists in haemophilia treatment centres in Canada: a modified Delphi approach
, , and | Nov 01, 2019
About this article
Article Category: Clinical Research
Published Online: Nov 01, 2019
Page range: 29 - 41
DOI: https://doi.org/10.17225/jhp00146
Keywords
© 2019 Karen Strike, Anthony Chan, Monica R. Maly, Patricia Solomon, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Figure 1
![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.](https://sciendo-parsed.s3.eu-central-1.amazonaws.com/647217b1215d2f6c89dbbaeb/j_jhp00146_fig_001.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20240518T015518Z&X-Amz-SignedHeaders=host&X-Amz-Expires=18000&X-Amz-Credential=AKIA6AP2G7AKP25APDM2%2F20240518%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Signature=5b1a21681c9c0e33a3e8e71e11c171eefa187eef4cd022868a461c03e1c5a884)
Figure 2
![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.](https://sciendo-parsed.s3.eu-central-1.amazonaws.com/647217b1215d2f6c89dbbaeb/j_jhp00146_fig_002.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20240518T015518Z&X-Amz-SignedHeaders=host&X-Amz-Expires=18000&X-Amz-Credential=AKIA6AP2G7AKP25APDM2%2F20240518%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Signature=b3a1edc9141626754c0b7e2657612d545582c13c1e4e3c6860ac435d326df093)
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 NO | TO A | TO A | TO A | NO | |
| 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 NO | TO A | TO A | TO A | NO | |
|---|---|---|---|---|---|
| 30. | |||||
| 31. | |||||
| 32. | |||||
| 33. | |||||
| 34. |