title: Facilitators and barriers to implementation of the ankle brachial index in outpatient physical therapy practice: a qualitative study.
abstract: BACKGROUND
  The ankle brachial index (ABI) is a valid and reliable measurement of lower extremity circulation and can be used as a screening tool for peripheral arterial disease (PAD), but the usage pattern in physical therapy practice is virtually unknown.
  
  
  OBJECTIVE
  This study was performed to describe the phenomenon of using the ABI in outpatient physical therapy practice.
  
  
  METHODS
  Nine participants from 3 different outpatient physical therapy clinics were provided with a hand held Doppler and education on how to accurately perform an ABI. Over a 3-month period, participants performed the ABI on any patient presenting with age > 50 with at least two risk factors for PAD. Immediately following the 3-month data collection period, two focus group interviews were performed to examine the therapist's experience using the ABI. Transcripts were analyzed to identify facilitators and barriers to implementation.
  
  
  RESULTS
  Facilitators identified include familiarity, ease of use, accuracy, and confidence with results. Barriers included flow and routine disruption, patient did not want/refused, and issues related to direct access.
  
  
  CONCLUSIONS
  Although some barriers to use of the ABI in an outpatient clinical setting need to be considered, most participants found the experience of using the ABI positive and feasible.
authors.affiliation: Widener University Institute for Physical Therapy Education.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Lefebvre
authors.forename: Crystal
authors.initials: C
authors.lastname: Cody
authors.forename: Erika
authors.initials: E
authors.lastname: Jayne
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mason
authors.forename: Rebecca
authors.initials: R
authors.lastname: Monaghan
authors.forename: Kerstin
authors.initials: K
authors.lastname: Palombaro
keywords: ankle brachial index; peripheral arterial disease; physical therapy