Barriers and facilitators to implementation of an exercise and education programme for osteoarthritis: a qualitative study using the consolidated framework for implementation research

• Published in: Rheumatology international Vol. 44; no. 6; pp. 1035 - 1050
• Main Authors: Bhardwaj, Avantika, FitzGerald, Christine, Graham, Margaret, MacFarlane, Anne, Kennedy, Norelee, Toomey, Clodagh M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2024; Springer Nature B.V
• Subjects: Aged; Arthritis; Attitude of Health Personnel; Denmark; Exercise Therapy - methods; Female; Humans; Male; Marketing; Medicine; Medicine & Public Health; Middle Aged; Observational Research; Osteoarthritis; Osteoarthritis, Hip - rehabilitation; Osteoarthritis, Hip - therapy; Osteoarthritis, Knee - rehabilitation; Osteoarthritis, Knee - therapy; Patient Education as Topic - methods; Physical Therapists - education; Qualitative Research; Rheumatology; Self-Management - education; Denmark; Facilitators; Self-management; OA; Exercise; Barriers; Implementation
• ISSN: 1437-160X; 0172-8172; 1437-160X
• DOI: 10.1007/s00296-024-05590-9

Targeted efforts to better understand the barriers and facilitators of stakeholders and healthcare settings to implementation of exercise and education self-management programmes for osteoarthritis (OA) are needed. This study aimed to explore the barriers and facilitators to the implementation of Good Life with osteoArthritis in Denmark (GLA:D), a supervised group guideline-based OA programme, across Irish public and private healthcare settings. Interviews with 10 physiotherapists (PTs; 8 public) and 9 people with hip and knee OA (PwOA; 4 public) were coded by the Consolidated Framework for Implementation Research (CFIR) constructs in a case memo (summary, rationale, quotes). The strong positive/negative implementation determinants were identified collaboratively by rating the valence and strength of CFIR constructs on implementation. Across public and private settings, PTs and PwOA strongly perceived GLA:D Ireland as evidence-based, with easily accessible education and modifiable marketing/training materials that meet participants’ needs, improve skills/confidence and address exercise beliefs/expectations. Despite difficulties in scheduling sessions (e.g., work/caring responsibilities), PTs in public and private settings perceived advantages to implementation over current clinical practice (e.g., shortens waiting lists). Only PTs in public settings reported limited availability of internal/external funding, inappropriate space, marketing/training tools, and inadequate staffing. Across public and private settings, PwOA reported adaptability, appropriate space/equipment and coaching/supervision, autonomy, and social support as facilitators. Flexible training and tailored education for stakeholders and healthcare settings on guideline-based OA management may promote implementation. Additional support on organising (e.g., scheduling clinical time), planning (e.g., securing appropriate space, marketing/training tools), and funding (e.g., accessing dedicated internal/external grants) may strengthen implementation across public settings.