title: What factors affect implementation of early rehabilitation into intensive care unit practice? A qualitative study with clinicians.
abstract: To identify the barriers and enablers that influence clinicians' implementation of early rehabilitation in critical care.
  
  
  
  Qualitative study involving 26 multidisciplinary participants who were recruited using purposive sampling. Four focus groups were conducted using semistructured questions to explore attitudes, beliefs, and experiences. Data were transcribed verbatim and thematic analysis was performed.
  
  
  
  Six themes emerged, as follows: (1) the clinicians' expectations and knowledge (including rationale for rehabilitation, perceived benefits, and experience), (2) the evidence for and application of rehabilitation (including beliefs regarding when to intervene), (3) patient factors (including prognosis, sedation, delirium, cooperation, motivation, goals, and family), (4) safety considerations (including physiological stability and presence of devices or lines), (5) environmental influences (staffing, resources, equipment, time, and competing priorities), and (6) culture and teamwork. Key strategies identified to facilitate rehabilitation included addressing educational needs for all multidisciplinary team members, supporting junior nursing staff, and potential expansion of physiotherapy staffing hours to closer align with the 24-hour patient care model.
  
  
  
  Key barriers to implementation of early rehabilitation in critical care are diverse and include both clinician- and health care system-related factors. Research targeted at bridging this evidence-practice gap is required to improve provision of rehabilitation.
authors.affiliation: Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Bldg, 161 Barry St, Parkville 3010, Victoria, Australia. Electronic address: selina.parry@unimelb.edu.au.
authors.forename: Selina M
authors.initials: SM
authors.lastname: Parry
authors.affiliation: Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Bldg, 161 Barry St, Parkville 3010, Victoria, Australia.
authors.forename: Louisa
authors.initials: L
authors.lastname: Remedios
authors.affiliation: Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Bldg, 161 Barry St, Parkville 3010, Victoria, Australia; Institute for Breathing and Sleep, Bowen Centre, Austin Hospital, 145 Studley Rd, Heidelberg 3084, Victoria, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Denehy
authors.affiliation: Department of Physiotherapy, Royal Melbourne Hospital, 300 Grattan St, Parkville 3050, Victoria, Australia.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Knight
authors.affiliation: Department of Physiotherapy, Royal Melbourne Hospital, 300 Grattan St, Parkville 3050, Victoria, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Beach
authors.affiliation: Department of Physiotherapy, Austin Hospital, 145 Studely Rd, Heidelberg 3084, Victoria, Australia.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Rollinson
authors.affiliation: Department of Physiotherapy, Austin Hospital, 145 Studely Rd, Heidelberg 3084, Victoria, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Berney
authors.affiliation: Critical Care, University College Hospital, London, United Kingdom.
authors.forename: Zudin A
authors.initials: ZA
authors.lastname: Puthucheary
authors.affiliation: Department of Critical Care, University of Kentucky, Lexington, KY.
authors.forename: Peter
authors.initials: P
authors.lastname: Morris
authors.affiliation: Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Bldg, 161 Barry St, Parkville 3010, Victoria, Australia; Institute for Breathing and Sleep, Bowen Centre, Austin Hospital, 145 Studley Rd, Heidelberg 3084, Victoria, Australia; Department of Physiotherapy, Royal Melbourne Hospital, 300 Grattan St, Parkville 3050, Victoria, Australia.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Granger
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003422:Critical Care / Q000458:organization & administration*; D016638:Critical Illness / Q000534:rehabilitation*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D017146:Models, Organizational; D010348:Patient Care Team; D026741:Physical Therapy Modalities; D014739:Victoria; D055815:Young Adult
keywords: Barriers; Implementation, recovery of function; Intensive care; Qualitative; Rehabilitation