Implementation Strategies
Implementation strategies are the actions needed to implement physical therapy for chronic pain. Ideally, implementation strategies should be selected to address the barriers to implementation discussed in the "Common Barriers and Facilitators" tab. Click the buttons on the left to read more about implementation strategies people have used to implement physical therapy for chronic pain and to access educational resources. In addition, view the RASC guide Strategies Timeline, Activities & Resources (STAR) log to discover a practical way to track these strategies and The Partner Engagement Guide to access practical recommendations to engage partners in your implementation strategies.
Physical therapy implementation strategies have primarily focused on innovation in the clinical care setting, the use of education materials and guides for clinicians and patients, and the adoption of telehealth services.
Evidence on the implementation of physical therapy primarily comes from clinical trials, observational studies, and qualitative studies.
Integration of physical therapists into other healthcare settings, such as primary care, ambulatory care, or acute care settings like an emergency department, can include adding a PT consult button to the electronic healthcare record consult system. This allows creating a new documentation form for acute care PT and conducting electronic and phone consults when the PT is not available. These innovations in PT delivery may enhance implementation.
Clinician profiles for each physical therapist can be developed to help clinicians understand their own progress toward higher-value care. Profiles can include patient volume, change in disability metrics, and average number of visits. Profiles can help clinicians identify successes and opportunities for improvement in their care delivery.
In an effort to promote high-value PT within a facility, a committee of physical therapists reviewed the literature to develop a 2-page treatment recommendation guide outlining evidence-based, best-practice guidelines for pathways of care for managing low back pain in PT. The guide was shared with colleagues and clinic directors. This program resulted in increased adherence to evidence-based physical therapies, improved clinical outcomes, including pain and functionality, and a decline in low-value care.
A program to implement group PT for knee osteoarthritis in a Veterans Affairs Healthcare setting reported that providing foundational support, consisting of a detailed self-guided toolkit for providers and program administrators and monthly support calls, can lead to effective program adoption and patient improvements. A study investigated whether an enhanced, individualized form of support was superior and concluded that the foundational support performed equally well in terms of implementation and patient outcomes. This work highlights the role of support in the implementation process of group PT.
An effort to integrate PT into an emergency department included developing a case series to present to medical residents that provided an overview of the PT scope and how physical therapists can assist in diagnosis and disposition decisions. Similar clinician-directed education could be adopted for other members of the healthcare system to promote perceived appropriateness of PT. Additional educational materials for patients, providing an overview of PT and its purpose in their care plan, may help support uptake.
The integration of Motivational Interviewing into standard PT care can help improve patient adherence to and maintenance of physical activity during and after the clinical episode. Specific components of Motivational Interviewing include using open-ended questions during the assessment phase, shared decision-making during treatment planning, and empowering the patient to problem-solve barriers to treatment success.
Physical therapy can be successfully delivered via telehealth by adapting key treatment components. For example, a physical therapist can conduct an initial assessment by observing the patient performing functional movements (e.g., bending forward, squatting, lifting), and treatment sessions can include customizable video modules demonstrating prescribed exercises and showing the patient performing them on camera.