#PEDroTacklesBarriers to evidence-based physiotherapy: success stories (part 2 – physiotherapy team perspective)

The #PEDroTacklesBarriers to evidence-based physiotherapy campaign shared tips on tackling the four biggest barriers to evidence-based physiotherapy – lack of time, language, lack of access, and lack of statistical skills.

The ‘#PEDroTacklesBarriers to evidence-based physiotherapy’ campaign is concluding with success stories showcasing how physiotherapists have overcome different barriers to ensure patients receive evidence-based care.

Last month we covered success stories from an individual clinician perspective in the fields of stroke rehabilitation and oncology. Our final month features how a physiotherapy team implemented evidence-based physiotherapy in their service.

Nicole Stockhill (physiotherapist at Toowoomba Hospital, Australia) presents the changes made to a balance class to bring it in line with evidence-based practice.

The context: Physiotherapists working in the geriatric and adult rehabilitation and stroke services team at Toowoomba Hospital, Australia read the best available evidence for falls prevention.

The evidence: High-quality evidence from a systematic review found that high-challenge balance exercises performed 3 or more hours per week reduces the risk of falls by 39%. High-challenge balance exercises are those where upper limb support is removed, the base of support is reduced and the centre of gravity moves.

The problem: The physiotherapists decided to evaluate their balance class to see if it aligned with this evidence. They found patients performed 2 hours of exercise a week compared to the recommended 3 or more hours and that only 31% of the exercise repetitions involved high-challenge balance exercises.

The barriers to implementation: The class needed an overhaul but there were some barriers to implementing the evidence. These included time to plan the new class and educate staff on the class structure and evidence, additional resources such as minor equipment additions and new home exercise programs which included high-challenge exercises, and time management to ensure physiotherapists could get patients through all the new exercises within an hour session.

The solution: The physiotherapy team tackled many of the barriers by restructuring the class to a circuit class format. Exercise stations with poster instructions allowed exercises to be tailored to individual abilities while maintaining the motivation for exercise gained through a group setting. Patients received goal-oriented instructions and feedback on their performance which improved their motivation to exercise. The result was a high challenge, high volume program which had little-to-no impact on staff requirements, resources and costs.

The outcomes: The average number of repetitions increased from 101 to 894 per class, and the percentage of repetitions involving high-challenge exercise increased from 31% to 100%. This resulted in improved balanced outcomes as assessed by the physiotherapists over time.

Maddie Jaeger (physiotherapist at Toowoomba Hospital, Australia). Maddie shares her experience working in a physiotherapy team that implemented evidence-based care into their balance class service.

Maddie describes the features of the class, how participants coped with the challenges and intensity of the class, the changes in participants’ measured outcomes, and their achievement of goals.

The ‘#PEDroTacklesBarriers to evidence-based physiotherapy’ campaign has now concluded. We hope you have enjoyed the strategies and tips shared to help you overcome barriers to evidence-based physiotherapy.

#PEDroTacklesBarriers to evidence-based physiotherapy campaign was supported by World Physiotherapy, Australian Physiotherapy Association, Società Italiana di Fisioterapia, Société Française de Physiothérapie, and Koninklijk Nederlands Genootschap voor Fysiotherapie.

PEDro acknowledges Joshua Zadro for coordinating this campaign. We would also like to acknowledge all campaign contributors, translation work from Mariana Nascimento Leite, Junior Vitorino Fandim (Portuguese), Leonardo Pellicciari, Francesco Ferrarello, Michele Marelli, Matteo Paci, Paolo Pillastrini (Italian), Magda Costa Castany, Gael Le Perf, Guillaume Galliou, Matthieu Guémann, Elodie Louvion (French), the PEDro Education and training committee and PEDro production support from Geraldine Wallbank, Courtney West and Anne Moseley.

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