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Barriers and facilitators to early rehabilitation in mechanically ventilated patients—a theory-driven interview study

BACKGROUND: Despite a supportive evidence base and a push to implement, the uptake of early rehabilitation in critical care has been inconsistent. The objective of this study was to explore barriers and facilitators to early rehabilitation for critically ill patients receiving invasive mechanical ve...

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Autores principales: Goddard, Shannon L., Lorencatto, Fabiana, Koo, Ellen, Rose, Louise, Fan, Eddy, Kho, Michelle E., Needham, Dale M., Rubenfeld, Gordon D., Francis, Jill J., Cuthbertson, Brian H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5781271/
https://www.ncbi.nlm.nih.gov/pubmed/29403646
http://dx.doi.org/10.1186/s40560-018-0273-0
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author Goddard, Shannon L.
Lorencatto, Fabiana
Koo, Ellen
Rose, Louise
Fan, Eddy
Kho, Michelle E.
Needham, Dale M.
Rubenfeld, Gordon D.
Francis, Jill J.
Cuthbertson, Brian H.
author_facet Goddard, Shannon L.
Lorencatto, Fabiana
Koo, Ellen
Rose, Louise
Fan, Eddy
Kho, Michelle E.
Needham, Dale M.
Rubenfeld, Gordon D.
Francis, Jill J.
Cuthbertson, Brian H.
author_sort Goddard, Shannon L.
collection PubMed
description BACKGROUND: Despite a supportive evidence base and a push to implement, the uptake of early rehabilitation in critical care has been inconsistent. The objective of this study was to explore barriers and facilitators to early rehabilitation for critically ill patients receiving invasive mechanical ventilation. METHODS: Using the Theoretical Domains Framework (TDF) of behavior change, we conducted semi-structured interviews exploring barriers and facilitators to early rehabilitation among four purposively sampled ICU clinician groups (nurses, rehabilitation professionals, respiratory therapists, and physicians). The TDF is a comprehensive framework of 14 “construct domains,” synthesized from 33 theories of behavior that was developed to study determinants of behavior and to design interventions to improve evidence-based healthcare practice. A topic guide was developed and piloted based on the TDF and expert knowledge. Interviews were audio-recorded and transcribed verbatim. Transcripts were content analyzed by coding items into domains and then synthesized into more specific, over-arching themes or “beliefs.” An expert consensus group used structured decision rules to classify beliefs as high, moderate, or low in importance. RESULTS: We interviewed 40 stakeholders from the four clinician groups and identified 135 separate beliefs. Of these, 19 were classified as high, 40 as moderate, and 76 of low importance as barriers or facilitators. All beliefs classified as highly important fell within one of seven TDF domains: skills, social/professional role and identity, beliefs about capabilities, beliefs about consequences, environmental context/resources, social influences, and behavioral regulation. Beliefs of lower importance fell under the following seven domains: knowledge; optimism; reinforcement; intention; goals; memory, attention, and decision processes; and emotion. Quantitative differences in stated beliefs about early rehabilitation between professional groups were not common. CONCLUSIONS: This study identified important barriers and facilitators to early rehabilitation in critical care patients. Domains identified as important should be considered when designing interventions to increase uptake of early rehabilitation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40560-018-0273-0) contains supplementary material, which is available to authorized users.
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spelling pubmed-57812712018-02-05 Barriers and facilitators to early rehabilitation in mechanically ventilated patients—a theory-driven interview study Goddard, Shannon L. Lorencatto, Fabiana Koo, Ellen Rose, Louise Fan, Eddy Kho, Michelle E. Needham, Dale M. Rubenfeld, Gordon D. Francis, Jill J. Cuthbertson, Brian H. J Intensive Care Research BACKGROUND: Despite a supportive evidence base and a push to implement, the uptake of early rehabilitation in critical care has been inconsistent. The objective of this study was to explore barriers and facilitators to early rehabilitation for critically ill patients receiving invasive mechanical ventilation. METHODS: Using the Theoretical Domains Framework (TDF) of behavior change, we conducted semi-structured interviews exploring barriers and facilitators to early rehabilitation among four purposively sampled ICU clinician groups (nurses, rehabilitation professionals, respiratory therapists, and physicians). The TDF is a comprehensive framework of 14 “construct domains,” synthesized from 33 theories of behavior that was developed to study determinants of behavior and to design interventions to improve evidence-based healthcare practice. A topic guide was developed and piloted based on the TDF and expert knowledge. Interviews were audio-recorded and transcribed verbatim. Transcripts were content analyzed by coding items into domains and then synthesized into more specific, over-arching themes or “beliefs.” An expert consensus group used structured decision rules to classify beliefs as high, moderate, or low in importance. RESULTS: We interviewed 40 stakeholders from the four clinician groups and identified 135 separate beliefs. Of these, 19 were classified as high, 40 as moderate, and 76 of low importance as barriers or facilitators. All beliefs classified as highly important fell within one of seven TDF domains: skills, social/professional role and identity, beliefs about capabilities, beliefs about consequences, environmental context/resources, social influences, and behavioral regulation. Beliefs of lower importance fell under the following seven domains: knowledge; optimism; reinforcement; intention; goals; memory, attention, and decision processes; and emotion. Quantitative differences in stated beliefs about early rehabilitation between professional groups were not common. CONCLUSIONS: This study identified important barriers and facilitators to early rehabilitation in critical care patients. Domains identified as important should be considered when designing interventions to increase uptake of early rehabilitation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40560-018-0273-0) contains supplementary material, which is available to authorized users. BioMed Central 2018-01-23 /pmc/articles/PMC5781271/ /pubmed/29403646 http://dx.doi.org/10.1186/s40560-018-0273-0 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Goddard, Shannon L.
Lorencatto, Fabiana
Koo, Ellen
Rose, Louise
Fan, Eddy
Kho, Michelle E.
Needham, Dale M.
Rubenfeld, Gordon D.
Francis, Jill J.
Cuthbertson, Brian H.
Barriers and facilitators to early rehabilitation in mechanically ventilated patients—a theory-driven interview study
title Barriers and facilitators to early rehabilitation in mechanically ventilated patients—a theory-driven interview study
title_full Barriers and facilitators to early rehabilitation in mechanically ventilated patients—a theory-driven interview study
title_fullStr Barriers and facilitators to early rehabilitation in mechanically ventilated patients—a theory-driven interview study
title_full_unstemmed Barriers and facilitators to early rehabilitation in mechanically ventilated patients—a theory-driven interview study
title_short Barriers and facilitators to early rehabilitation in mechanically ventilated patients—a theory-driven interview study
title_sort barriers and facilitators to early rehabilitation in mechanically ventilated patients—a theory-driven interview study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5781271/
https://www.ncbi.nlm.nih.gov/pubmed/29403646
http://dx.doi.org/10.1186/s40560-018-0273-0
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