title: Understanding the barriers and enablers to implementation of a self-managed exercise intervention: a qualitative study.
abstract: BACKGROUND
  Despite a proliferation of research evidence, there remains a 'gap' between what this evidence suggests and what happens in clinical practice. One reason why physiotherapists might not implement research evidence is because the findings do not align with their current practice preferences.
  
  
  OBJECTIVE
  While conducting a multicentre RCT we aimed to explore possible implementation barriers and facilitators with regard to the intervention under evaluation; a self-managed loaded exercise programme for rotator cuff tendinopathy.
  
  
  METHODS
  A qualitative study within the framework of a mixed methods design. Data was collected using individual semi-structured interviews and analysed using the framework method.
  
  
  METHODS
  Three NHS physiotherapy departments.
  
  
  METHODS
  Thirteen physiotherapists.
  
  
  RESULTS
  Six themes were generated: (1) the physiotherapists preferred therapeutic option; (2) the role of the physiotherapist; (3) attributes of the intervention; (4) attitude to symptom response; (5) response to therapy, and (6) continuing professional development. Differences between the preferred therapeutic approach of the physiotherapists and the self-managed exercise intervention were apparent; particularly in relation to the type and number of exercises, the use of manual therapy and the extent of loading. The physiotherapists recognised their role as knowledge translators but certain attributes of the intervention appeared to serve as both a barrier and facilitator; particularly the simplicity. Opinion regarding the optimal symptom response during exercise prescription also differed.
  
  
  CONCLUSIONS
  Some relevant and important physiotherapist related barriers and facilitators concerning implementation of research findings have been identified. The influence of these factors needs to be recognised and considered.
authors.affiliation: School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. Electronic address: c.littlewood@sheffield.ac.uk.
authors.forename: Chris
authors.initials: C
authors.lastname: Littlewood
authors.affiliation: The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research & Care (CLAHRC) for South Yorkshire, Sheffield Teaching Hospitals, 11 Broomfield Road, Sheffield S10 2SE, UK. Electronic address: s.mawson@sheffield.ac.uk.
authors.forename: Sue
authors.initials: S
authors.lastname: Mawson
authors.affiliation: Faculty of Health & Wellbeing, Sheffield Hallam University, Sheffield, UK. Electronic address: s.may@shu.ac.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: May
authors.affiliation: School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. Electronic address: s.j.walters@sheffield.ac.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: Walters
mesh_terms: D001291:Attitude of Health Personnel; D004059:Diffusion of Innovation; D004496:Education, Continuing; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D059825:Physical Therapists / Q000523:psychology*; D024382:Professional Role; D017006:Rotator Cuff; D012648:Self Care; D052256:Tendinopathy / Q000534:rehabilitation*
keywords: Implementation of research; Qualitative research; Rotator cuff; Self-management; Tendinopathy