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

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

doi:10.17225/jhp00146

Abstract

Abstract Background

In patients with haemophilia, evidence suggests that the physical examination alone is not sensitive enough to detect small amounts of blood within a joint. Attention has shifted to methods of improving the sensitivity of the physical examination through adding diagnostic modalities such as point-of-care ultrasonography (POC-US). Proficiency with the physical examination and understanding of the role of POC-US are important competencies for physiotherapists. Despite training, implementation of POC-US by physiotherapists in haemophilia treatment centres in Canada has been mixed.

Aim

Using a theory-based approach, the aim of the current study is to achieve expert consensus regarding the barriers to physiotherapy performed POC-US in haemophilia treatment centres in Canada using a modified Delphi approach.

Materials and Methods

Using the Knowledge-to-Action Framework and the Consolidated Framework for Implementation Research (CFIR), a modified Delphi approach was completed using the Modified BARRIERS Scale (MBS). Participants were blinded and consensus was reached over three rounds at the Canadian Hemophilia Society’s annual three-day conference.

Results

Twenty-two physiotherapists participated; 20 participants completed Round 1, and 21 completed Rounds 2 and 3. Four items of the MBS reached consensus: 1) The physiotherapist does not have time to read research related to POC-US; 2) The physiotherapist is isolated from knowledgeable colleagues with whom to discuss POC-US; 3) Administration will not allow POC-US implementation; 4) There is insufficient time on the job to implement new ideas. All four consensus items can be mapped to one domain of the CFIR: the inner setting.

Conclusion

The haemophilia treatment centre within a healthcare organisation appears to be an important target for addressing barriers to the implementation of physiotherapy performed POC-US.

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Authors

Karen Strike

christkl@mcmaster.ca

Assistant Clinical Professor, School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada .
Anthony Chan

Professor, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
Monica R. Maly

Associate Professor, School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada .
Patricia Solomon

Professor, School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada .