Implementation tools for rehabilitation guidelines
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Table III. Example of the description of the implementation objectives
Principal objectives
Who has to
change practice? Expected change in practice
Rehabilitation
To ensure the timely,
Patient
systematic, and progressive
and long enough therapeutic
exercise (minimum 3 months)
in degenerative tendon
problems
Physiotherapists
Physicians
Barriers to change How to put the change into practice
Lack of motivation Leaflet to patients
Laziness Active follow-up of response to exercise
Pain Good pain treatment
Guide self-care methods to patient Lack of coaching
Lack of knowledge Organize follow-up of self-care Lack of resources Possibility to contact professionals easily
Group interventions (group exercise for
patients with musculoskeletal problems,
individualized exercise in small groups)
Understand the meaning of
rehabilitation Attitudes Refer to physiotherapist timely Lack of knowledge of local
Multiprofessional education
care pathway
Engage to self-care and rehabilitation
Lack of knowledge
Guide patients to self-care methods
Engagement of patients in
self-care
Patients
Professionals:
physiotherapists
or physicians
Is responsible for rehabilitation and
self-care
Lack of co-operation
Attitudes Leaflet to patients
Lack of motivation Active follow-up methods
Laziness Good pain treatment
Pain Possibilities to contact and ask advice
easily
Contradictory counselling
Guide patients to self-care methods and Lack of knowledge
make an agreement with patient how to Abilities to motivate
carry the programme out
Hurry
Organize follow-up of self-care
Structures and procedures
guidelines (mean 3.8–4.4) (Table II). Patient material
was rated as the most useful tool.
A total of 4 educational seminars were arranged during
the project, with 610 professionals attending. The first,
entitled “From patient to a rehabilitee – from rehabilitee
to coping with the illness” explored prevention of youth
marginalization, rehabilitation of musculoskeletal disor-
ders and the organization of rehabilitation. The topics of
the other seminar were cardiac rehabilitation, treatment
and rehabilitation of ADHD (Attention-deficit hyper
activity disorder) and hip fracture. In addition, 2,156
professionals attended 14 CME sessions arranged as
part of CME events.
Feedback from participants was mainly positive
regarding the usefulness of topics and the content of
the 4 seminars arranged during the project. On a scale
from 1 (disagree) to 5 (agree), the mean value for the
majority of lectures was greater than 4.
Multiprofessional education
To make an agreement on work
distribution between physicians and
physiotherapists
To make an agreement about work
distribution between physicians and
physiotherapists, and about procedures
Multiprofessional education
Implementation of seamless care pathways
The group that prepared the implementation of the
CC guideline on shoulder tendon disorders held 5
meetings between June 2016 and March 2017. The
group identified important objectives of change and
how these aims could be put into practice. They divided
the aims into 4 categories: diagnostics, pain treatment,
rehabilitation, and the care pathway. In addition, the
aims were prioritized.
Progressive, systematic, timely, and sufficiently
long-lasting therapeutic exercise period for patients
with shoulder tendon problems was identified as the
most important implementation theme. Engagement
of patients with self-care was perceived as another
important rehabilitation-related implementation aim.
The group defined the aims in a table, including target
group, barriers and facilitators, and possible means (in-
terventions) to drive change. As an example, Table III
Table IV. Agreed actions to implement the Current Care Guideline on shoulder tendon problems
What to be done Who is responsible? Schedule Present state
Model of care for working aged patients with
musculoskeletal diseases Chief of physiotherapy Starting in Spring
2017, ready in 2018 Underway
Spring 2017 Done
Chief of rehabilitation
Agreement and documentation of work distribution between Physiotherapist and physician from the primary
physicians and physiotherapists, and of procedures
healthcare named by the group responsible for
implementation
Planning and starting the group physiotherapy
Chief of physiotherapy
Education in multiprofessional small groups addressed to
Chief of rehabilitation
primary care physicians and physiotherapists
Specialist in orthopaedic surgery
Agreement and documentation of how to consult
Physiotherapists from primary care
Chief of rehabilitation
Spring 2017
Done
Autumn 2017 to Spring Done
2018
Spring 2017 Underway
Spring and Autumn
2017 Underway
Specialist in orthopaedic surgery
Leaflet for patients about self-care
Representative of primary healthcare
Physiotherapist
Chief of rehabilitation
J Rehabil Med 51, 2019