Barriers and facilitators to implementation of outcome measures among physiotherapists in Nepal: A mixed-methods study

Anupa Pathak; J Haxby Abbott; Nibha Bajracharya; Gagan Gurung; Govinda Mani Nepal; Saurab Sharma

doi:10.1016/j.msksp.2023.102859

Barriers and facilitators to implementation of outcome measures among physiotherapists in Nepal: A mixed-methods study

Musculoskelet Sci Pract. 2023 Nov:68:102859. doi: 10.1016/j.msksp.2023.102859. Epub 2023 Sep 15.

Authors

Anupa Pathak¹, J Haxby Abbott², Nibha Bajracharya³, Gagan Gurung⁴, Govinda Mani Nepal⁵, Saurab Sharma⁶

Affiliations

¹ Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago, New Zealand; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. Electronic address: anupa.pathak@sydney.edu.au.
² Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago, New Zealand.
³ Department of Physiotherapy, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal.
⁴ Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand.
⁵ Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
⁶ Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia.

PMID: 37844424
DOI: 10.1016/j.msksp.2023.102859

Abstract

Background: Standardised outcome measures are essential to evidence-based practice but their implementation remains a significant challenge in low- and middle-income countries. The barriers and enablers for implementation of outcome measures are likely different in these settings.

Objectives: We sought to understand barriers and facilitators to use of standardised outcome measures (e.g. patient-reported, performance-based, clinician-reported) in clinical practice among physiotherapists in Nepal.

Design: Exploratory sequential mixed-method study.

Methods: We conducted focus groups with physiotherapists in Nepal to understand factors contributing to standardised outcome measure use/non-use in depth and thematically analysed the data using Consolidated Framework for Implementation Research (CFIR). To triangulate the findings, we used an online survey which was distributed to practicing physiotherapists in Nepal using social media.

Results: We interviewed 26 physiotherapists for the qualitative phase and 125 physiotherapists responded to our online survey. The most endorsed facilitator was mandating outcome measure use through regulations at organisational or national level, for example, submission of patient-level outcome measures to an insurance system. Major barriers were lack of time, lack of outcome measures in local languages, inability to follow-up with patients and perceived inability of patients to understand outcome measures. Challenges that had not yet been identified in previous studies were inability to follow-up with patients and organisational culture (e.g., cultural hierarchy within an institution).

Conclusion: The findings of our study provide an understanding of the contextual needs, and potential way forward for implementation of outcome measures in developing countries like Nepal. Future studies should focus on establishing consensus on which measures to use, the cross-cultural adaptation of these measures, and developing pathways for regulation.

Keywords: Barriers; Facilitators; Implementation; Low-middle income country; Outcome measures.

MeSH terms

Focus Groups
Humans
Nepal
Outcome Assessment, Health Care
Physical Therapists*