Barriers to the implementation of point-of-care ultrasonography by physiotherapists in haemophilia treatment centres in Canada: a modified Delphi approach
01 nov 2019
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Categoría del artículo: Clinical Research
Publicado en línea: 01 nov 2019
Páginas: 29 - 41
DOI: https://doi.org/10.17225/jhp00146
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© 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-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA6AP2G7AKOUXAVR44%2F20250913%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Date=20250913T113530Z&X-Amz-Expires=3600&X-Amz-Signature=ee382d96a631d76394dac04db6ef3b9bda69ab72148ea7e4fd6a76d288cc4941&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject)
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-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA6AP2G7AKOUXAVR44%2F20250913%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Date=20250913T113530Z&X-Amz-Expires=3600&X-Amz-Signature=c5e76c16957f390d70ec6dc2fe162a73ed23498a9a79da5d3dd2c4e89d723b08&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject)

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 | |
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30. | |||||
31. | |||||
32. | |||||
33. | |||||
34. |