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.

本研究旨在探究医疗专业人员对急性鞭击相关障碍（acute whiplash associated disorders, WAD）诊疗指南的接受度，并明确遵行该指南的阻碍因素与促进因素。本研究为质性描述性研究，招募在澳大利亚新南威尔士州与昆士兰州的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（focus group discussions）。

共计28名医疗专业人员参与本次研究，其中物理治疗师19名、脊医6名、整骨医师3名；共开展6场半结构化焦点小组讨论（semi-structured focus group discussions），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进行。讨论过程均进行音频录制，并生成去标识化的逐字转录文本。研究采用归纳法（inductive approach）开展主题分析（thematic analysis），以识别群体普遍持有的认知观念。

研究结果显示，指南推荐意见的接受度受到三类因素的影响：指南自身特征、从业者及执业环境特征、患者相关因素。具体而言，相互冲突的信念体系、指南推荐意见的模糊性，以及患者的特征与预期，会对指南接受度造成阻碍。总体而言，从业者对使用该指南持积极态度；但在部分场景中，对核心推荐意见的接受呈现出选择性。

未来的指南修订与推广工作可聚焦于以下方向：阐释指南的底层原则、提供更细化的推荐意见，以及采用相关策略以纠正不一致的信念、促进审慎决策。

**康复领域应用启示**：若医疗人员选择性接受指南推荐意见，优先选择无需调整执业模式的内容，将为难在WAD管理中推行循证实践（evidence-based practice）带来挑战。参与研究的从业者对指南核心信息与推荐意见的态度存在差异，有时甚至呈现两极分化。指南制定者需进一步强化对从业者信念与态度的重塑，同时更好地阐释指南的底层原则，并提供更详尽的推荐意见。

选择性接受指南推荐意见、优先采纳无需调整执业模式的内容，或将为难在WAD管理中推行循证实践带来挑战。参与研究的从业者对指南核心信息与推荐意见的态度存在差异，有时甚至呈现两极分化。指南制定者需进一步强化对从业者信念与态度的重塑，同时更好地阐释指南的底层原则，并提供更详尽的推荐意见。