Physical Therapists' adoption of the Lumbopelvic Manipulation Clinical Prediction Rule and Lumbopelvic Manipulation following a multi-component training program
Date
2013-08
Authors
Ortel, Jesse
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Abstract
Low Back Pain is a common and costly condition in the United States. Unfortunately standard management and treatment of low back pain in our healthcare system, including that provided by physical therapists, is less than optimal. Two relatively new innovations in physical therapy have been widely supported in research as effective at improving low back pain; these innovations are the lumbopelvic manipulation clinical prediction rule (LMCPR) and lumbopelvic manipulation (LM). Despite their proven effectiveness, these innovations have not been widely adopted by physical therapists. Knowing why physical therapists are adopting or not adopting the LMCPR and LM could provide insights that may lead to more targeted and effective training interventions that increase adoption. This mixed methods study followed 10 outpatient orthopedic physical therapists' over a twelve week period to look at their process of adoption of the LMCPR and LM following a multi-component training program on those topics. The results confirmed low adoption rates of the two innovations after prior training, and favorable perceptions and high self-reported adoption rates of both innovations following this study's multi-component training program. Most importantly, looking at the adoption process revealed common facilitating factors related to training design (e.g. post-training support), trainee characteristics (e.g. feeling accountable to try and/or adopt the innovations), and work environment (e.g. attending training with co-workers). The most important adoption barriers were related to trainee characteristics (e.g. use of non-LMCPR criteria (i.e. screening criteria) when making clinical decisions), and work environment factors (e.g. limited use opportunities). Future LMCPR and LM training programs that address the common facilitators and barriers identified in this study, may result in higher levels of adoption into practice.
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Keywords
Education, Physical therapy, Design, Adoption of new skills, Design based research, Lumbopelvic manipulation, Lumbopelvic manipulation clinical prediction rule, Physical therapists training, Training transfer