Understanding the barriers and enablers to implementation of a self-managed exercise intervention: A qualitative study

Background: Despite a proliferation of research evidence, there remains a ‘gap’ between what this evidence suggests and what happens in clinical practice. One reason why physiotherapists might not implement research evidence is because the findings do not align with their current practice preferences. Objectives: While conducting a multi-centre RCT we aimed to explore possible implementation barriers and facilitators with regard to the intervention under evaluation; a self-managed loaded exercise programme for rotator cuff tendinopathy. Design: A qualitative study within the framework of a mixed methods design. Data was collected using individual semi-structured interviews and analysed using the framework method. Setting: Three NHS physiotherapy departments. Participants: Thirteen physiotherapists. Results: Six themes were generated: 1) the physiotherapists preferred therapeutic option; 2} the role of the physiotherapist; 3) attributes of the intervention; 4) attitude to symptom response; 5) response to therapy, and 6) continuing professional development. Differences between the preferred therapeutic approach of the physiotherapists and the self-managed exercise intervention were apparent; particularly in relation to the type and number of exercises, the use of manual therapy and the extent of loading. The physiotherapists recognised their role as knowledge translators but certain attributes of the intervention appeared to serve as both a barrier and facilitator; particularly the simplicity. Opinion regarding the optimal symptom response during exercise prescription also differed. Conclusion: Some relevant and important physiotherapist related barriers and facilitators concerning implementation of research findings have been identified. The influence of these factors needs to be recognised and considered.