Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

First Advisor

Morey Kolber

Date of original Performance / Presentation

January 2024

Publication Date / Copyright Date

1-1-2024

Abstract

Introduction: Adherence to clinical practice guidelines (CPG) improves clinical outcomes, reduces healthcare utilization, and lowers costs. Before a CPG can impact clinical and financial outcomes, it must first enhance clinicians’ knowledge and ability to integrate it into practice. This study investigated the gap between physical therapists’ (PTs) self-reported guideline awareness, agreement, adoption, vignette adherence, and their actual use of CPG-recommended interventions for low back pain (LBP). Additionally, it evaluated the impact of the American Physical Therapy Association’s LBP guidelines on patient management, outcomes, and care costs. Methods: A combination of cross-sectional survey and retrospective cohort design was used. A survey was emailed to 73 outpatient PTs across 8 states, measuring awareness and agreement with CPG-recommendations and management of 3 clinical vignettes. Proportions of PTs aware, agreeing, adopting, and adhering to CPGs were calculated. Retrospective patient data assessed their use of CPG interventions and their effectiveness on Oswestry Disability Index (ODI) and care costs. Statistical analyses calculated associations between patient, clinic, and clinician characteristics and CPG awareness, agreement, vignette adherence, and adherence in clinical practice. Clinical adherence, ODI scores, and care costs were compared among PTs at each level of CPG adherence. Results: Among 60 respondents, awareness was 78.3%, agreement 85 %, adoption 65%, and vignette adherence 10%. Awareness (rs=0.377, p=.001), agreement (rs=0.386, p=.001), and mean adoption (rs= 0.234, p=.036) significantly correlated with mean adherence. Among PTs, there was a significant gap between PTs who agreed with CPG (84%) versus those who consistently demonstrated clinical adherence (42%). PTs agreeing with CPGs were 2.5 times more likely to provide adherent care, increasing to 3.8 times for those meeting clinical adherence. Overall, patients receiving adherent care were 1.7 times more likely to attain successful ODI outcomes. Non-recommended care costs were lower for PTs with CPG knowledge and adherence, however, total costs were higher for those meeting CPG adherence at every level than their counterparts. Conclusion: Adherence to CPG among PTs is a multi-step process. Increased knowledge alone does not ensure consistent clinical adherence. A gap between knowledge and practice continues to hinder the optimal management of patients with LBP.

Disciplines

Physical Therapy

Keywords

Clinical practice guidelines; Knowledge to practice gap; Knowledge translation; Low Back Pain; Physical Therapy

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