Bridging the gap between research-based knowledge and clinical practice: a qualitative examination of patients and physiotherapists’ views on the Otago exercise Programme

BACKGROUND: Falls and fall-related injuries exacerbate the health problems of older adults, and they are a public health concern. Despite an abundance of research, the implementation of evidence-based fall prevention programs has been slow and limited, additionally and these programs have not reduced the incidence of falling. Therefore, the primary objective of the present study was to examine patients and physiotherapists’ views on the factors that influence the implementation of the community- and evidence-based Otago Exercise Programme for fall prevention. METHODS: We conducted eight in-depth interviews with physiotherapists and patients, and a focus group interview with 12 physiotherapists and authority figures who represented local hospitals and municipalities. The resultant qualitative data were subjected to thematic analysis. RESULTS: The analysis yielded two main themes: the researcher’s role and position in the implementation process and the tension between research-based knowledge and clinical practice. The participants believed that research-based knowledge can address the challenges of clinical practice. Further, the patients reported that the fall prevention program made them feel safe and enhanced their ability to cope with daily life. The physiotherapists also observed that research findings do not readily translate into clinical practice. Further, they contended that research-based knowledge is not universal and that it cannot be generalized across different contexts; instead, it must be adapted and translated into a user-friendly language. The findings suggest that the application of research-based knowledge does equate to filling up empty jars and that research-based knowledge does not flow from the expert to the non-expert as water through a tube. Indeed, physiotherapists and patients are not tabula rasa. Additionally, the participants believed that researchers and stakeholders must think critically about who has the power and voice to create a common understanding. CONCLUSIONS: Our findings delineate the means by which the gap between research and practice regarding the Otago fall prevention program can bridged. The program can guide clinical work and provide important information that can be used to improve the quality of other fall prevention programs. However, the research-based knowledge that it confers must be adapted for use in clinical contexts.