Selective acceptance of acute whiplash guidelines: a qualitative analysis of perceptions of health professionals in Australia

To explore health professionals’ acceptance of the guidelines for acute whiplash associated disorders (WAD), and to identify barriers and facilitators to adherence. Qualitative descriptive study involving focus group discussions among health professionals who treat people with WAD in primary and secondary care settings in New South Wales and Queensland, Australia. Twenty-eight health professionals (physiotherapists = 19; chiropractors = 6; osteopaths = 3) participated in six semi-structured focus group discussions that were held in independent offices in Sydney and Brisbane, Australia between September and December 2015. Discussions were audio recorded and verbatim, de-identified transcripts produced. Thematic analysis was conducted using an inductive approach to identify commonly held beliefs. Acceptance of guideline recommendations appeared to be influenced by factors related to the guideline itself, practitioner and practice characteristics, and patient-related factors. Specifically, acceptance was hindered by conflicting belief systems, ambiguity in guideline recommendations, and patient characteristics and expectations. Practitioners demonstrated a positive attitude towards the use of the guidelines in general; however, in some cases, acceptance of key recommendations appeared selective. Future guideline revision and implementation might focus on explaining the underlying principles of the guidelines, providing more detailed recommendations, and involving strategies that challenge inconsistent beliefs and promote informed decision-making. IMPLICATIONS FOR REHABILITATIONSelective acceptance of guideline recommendations in favour of those not requiring practice change may present a challenge for the implementation of evidence-based practice in the management of whiplash.Participants demonstrated variable, sometimes polar attitudes to guideline key messages and recommendations.Guideline developers need to focus more strongly on changing practitioner beliefs and attitudes, as well as better explaining the underlying principles of the guidelines, and providing more detailed recommendations. Selective acceptance of guideline recommendations in favour of those not requiring practice change may present a challenge for the implementation of evidence-based practice in the management of whiplash. Participants demonstrated variable, sometimes polar attitudes to guideline key messages and recommendations. Guideline developers need to focus more strongly on changing practitioner beliefs and attitudes, as well as better explaining the underlying principles of the guidelines, and providing more detailed recommendations.本研究旨在探讨医疗专业人员对急性颈部扭伤相关疾患（acute whiplash associated disorders, WAD）诊疗指南的接受度，并明确其依从性的阻碍因素与促进因素。本研究为定性描述性研究，招募澳大利亚新南威尔士州与昆士兰州基层及二级医疗环境中接诊WAD患者的医疗专业人员开展焦点小组讨论。 共纳入28名医疗专业人员（物理治疗师19名、脊医6名、整骨医师3名），于2015年9月至12月间在澳大利亚悉尼与布里斯班的独立办公场所开展6场半结构化焦点小组讨论。所有讨论均进行录音，并生成去标识化的逐字转录文本。本研究采用归纳式主题分析法，以识别参与者共有的信念体系。 指南推荐意见的接受度似乎受三类因素影响：指南自身属性、医疗从业者及其执业特征，以及患者相关因素。具体而言，冲突性信念体系、指南推荐意见的模糊性，以及患者的特征与预期，均会阻碍对指南的接受。总体而言，医疗从业者对使用指南持积极态度，但在部分场景中，对核心推荐意见的接受呈现选择性。未来的指南修订与落地工作可聚焦于：阐释指南的底层原则、提供更细化的推荐意见，以及采用可修正不一致信念、助力知情决策的相关策略。 【康复领域应用启示】 选择性接受指南推荐意见（即优先采纳无需改变现有执业模式的推荐内容）可能为WAD管理中循证实践的落地带来挑战。参与者对指南核心信息与推荐意见的态度存在差异，甚至有时呈现两极分化。指南制定者需进一步强化对医疗从业者信念与态度的引导，同时优化指南底层原则的阐释工作，并提供更详尽的推荐意见。 选择性接受指南推荐意见（即优先采纳无需改变现有执业模式的推荐内容）可能为WAD管理中循证实践的落地带来挑战。参与者对指南核心信息与推荐意见的态度存在差异，甚至有时呈现两极分化。指南制定者需进一步强化对医疗从业者信念与态度的引导，同时优化指南底层原则的阐释工作，并提供更详尽的推荐意见。