@misc{PieperBehnkeDumkeetal., author = {Pieper, Dawid and Behnke, Eva-Maria and Dumke, Rieke and Kehr-Fuckel, Christel and Radow, Carolin and Schulze, Nils and Follmann, Markus and Schaefer, Corinna and Prill, Robert and Kopkow, Christian and Bahns, Carolin and Choi, Kyung-Eun (Anna) and Fischer, Lena}, title = {Awareness of adapting clinical practice guidelines to a local context}, series = {Clinical and public health guidelines}, volume = {2}, journal = {Clinical and public health guidelines}, number = {3}, publisher = {Wiley}, address = {Hobken, New Jersey}, issn = {2836-3973}, doi = {10.1002/gin2.70025}, pages = {1 -- 7}, abstract = {Background Guideline recommendations are often not implemented in practice. This can be attributed to factors such as patient preferences and characteristics, structural conditions, personnel or other resources, as well as cultural or ethical aspects. Adaptations to the local context (e.g., regional or hospital) result in so-called locally adapted guidelines (LAGL), which could improve implementation. We aimed to assess the awareness of LAGL among guideline developers in Germany. Methods An online survey was conducted via LimeSurvey in May 2024. The questionnaire, designed based on literature and expert opinions, consisted of 23 items, predominantly with dichotomous response options. Recruitment was conducted via email. Direct contact addresses were identified using the German guideline registry (n = 397). Additionally, a mailing list distribution was conducted through the guidelines working group of the German Network for Evidence-Based Medicine (n = 316). Only fully completed questionnaires were included in the analysis. Data cleaning and descriptive analysis were performed using Excel. Results A total of 63 questionnaires were fully completed. The most represented groups were physicians (65\%) and methodologists (24\%), most frequently in coordination (76\%) or as group members (62\%). The most judicious reasons for developing a LAGL were differences in patient populations (48\%), currency of recommendations (46\%), and patient values and preferences (44\%). The most commonly cited likely reasons for developing a LAGL were economic considerations (32\%), differences in patient populations (30\%), and currency of recommendations (30\%). Many respondents (59\%) were aware of the possibility of adapting existing guidelines to the local context. Among these, approximately half (49\%) had already locally adapted a guideline, with 75\% using an adaptation framework. Discussion LAGLs are known among guideline developers in Germany and are generally developed using adaptation frameworks. Potential reasons for preparing LAGLs are diverse, with some discrepancies between perceived valid and likely reasons. Highlights Over half (59\%) of surveyed clinical practice guideline (CPG) developers in Germany were aware of the possibility of adapting CPGs to local contexts, and nearly half of them had practical experience doing so. Although several adaptation frameworks exist, only 44\% of experienced adaptors were familiar with them, and among users, many found them only partly helpful. Differences in patient populations, outdated recommendations, and patient values were rated as the most valid reasons for local CPG adaptation, while economic factors were seen as the most likely driver in practice. Despite existing awareness, guideline adaptation to local settings remains underutilized and lacks structured implementation, highlighting the need for clearer definitions, better resources, and more practical examples.}, language = {en} } @misc{BahnsBremerMenkeetal., author = {Bahns, Carolin and Bremer, Alexander and Menke, Chiara Julia and Napierala-Komp, Simone and Hauke, Jeannine and Glaubitz, Andreas and Kopkow, Christian}, title = {Programmevaluation von GLA:D ® Deutschland: vorl{\"a}ufige Ergebnisse einer Mixed-Methods-Studie unter Verwendung des RE-AIM QuEST Frameworks}, series = {7. Forschungssymposium Physiotherapie der Deutschen Gesellschaft f{\"u}r Physiotherapiewissenschaft e.V.}, volume = {20}, journal = {7. Forschungssymposium Physiotherapie der Deutschen Gesellschaft f{\"u}r Physiotherapiewissenschaft e.V.}, number = {S 01}, publisher = {Thieme}, doi = {10.1055/s-0043-1777893}, language = {de} } @misc{BahnsBremerMenkeetal., author = {Bahns, Carolin and Bremer, Alexander and Menke, Chiara Julia and Napierala-Komp, Simone and Hauke, Jeannine and Glaubitz, Andreas and Kopkow, Christian}, title = {Implementierung von GLA:D ® in Deutschland - Effektivit{\"a}t im Nachuntersuchungszeitraum von 3 Monaten}, series = {7. Forschungssymposium Physiotherapie der Deutschen Gesellschaft f{\"u}r Physiotherapiewissenschaft e.V.}, volume = {20}, journal = {7. Forschungssymposium Physiotherapie der Deutschen Gesellschaft f{\"u}r Physiotherapiewissenschaft e.V.}, number = {S 01}, publisher = {Thieme}, doi = {10.1055/s-0043-1777892}, language = {de} } @misc{BahnsKopkow, author = {Bahns, Carolin and Kopkow, Christian}, title = {Barrieren und F{\"o}rderfaktoren in der Umsetzung leitliniengerechter Versorgung von Patient*innen mit H{\"u}ft- und/oder Kniegelenkarthrose in der physiotherapeutischen Praxis: eine qualitative Interviewstudie}, series = {7. Forschungssymposium Physiotherapie der Deutschen Gesellschaft f{\"u}r Physiotherapiewissenschaft e.V.}, volume = {20}, journal = {7. Forschungssymposium Physiotherapie der Deutschen Gesellschaft f{\"u}r Physiotherapiewissenschaft e.V.}, number = {S 01}, publisher = {Thieme}, doi = {10.1055/s-0043-1777891}, language = {de} } @misc{BahnsHappeKopkow, author = {Bahns, Carolin and Happe, Lisa and Kopkow, Christian}, title = {Barriers and facilitators to the use of clinical practice guidelines in osteoarthritis care: a qualitative study among German physiotherapists}, series = {BMJ Open}, volume = {14}, journal = {BMJ Open}, number = {10}, publisher = {BMJ}, issn = {2044-6055}, doi = {10.1136/bmjopen-2024-085349}, abstract = {Objectives The objective of this study was to explore barriers and facilitators to the use of clinical practice guidelines (CPGs) in osteoarthritis (OA) care among German physiotherapists. Design Qualitative semistructured interviews were conducted with German physiotherapists. An interview topic guide based on the Theoretical Domains Framework (TDF) was developed to explore perceived barriers and facilitators to the use of CPGs in OA care. Interviews were audio-recorded and transcribed verbatim. In a first step, the data were coded inductively using thematic analysis. Subsequently, the emerged themes were deductively reassigned to the relevant domains of the TDF and categorised as barriers and facilitators. Setting Outpatient physiotherapy practices in Germany. Participants Physiotherapists working in an outpatient setting in Germany and involved in the management of patients with hip and knee OA were eligible to participate. Results Eleven physiotherapists (7 women, 4 men) were interviewed between February and September 2023. The mean age was 34.2 years (± 9.9, range 23-57). Most factors influencing guideline-recommended care were identified in the TDF domains 'knowledge', 'beliefs about consequences', 'environmental context and resources' and 'social influences'. For example, physiotherapists perceived low awareness of existing CPGs, loss of individuality in treatment, time constraints and dissonant patient expectations as barriers to the use of CPGs. Discussion of guideline recommendations within the team and the expectation of improved patient outcomes and resource savings were reported as facilitators. Conclusions Multiple factors were identified that were perceived to influence clinical practice in Germany. The results of this study can inform the development of theory-based interventions aimed at changing physiotherapists' behaviour to support them in providing optimal OA care.}, language = {en} } @misc{BahnsKopkow, author = {Bahns, Carolin and Kopkow, Christian}, title = {Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice}, series = {BMC Musculoskeletal Disorders}, volume = {24}, journal = {BMC Musculoskeletal Disorders}, issn = {1471-2474}, doi = {10.1186/s12891-023-06464-0}, abstract = {Backround Osteoarthritis (OA) of the hip and the knee is common and leads to pain, stiffness and disability. Clinical practice guidelines (CPG) provide recommendations to assist healthcare professionals in clinical decision-making. Although evidence-based physiotherapy has been shown to be effective in the management OA, a gap between clinical practice and guideline recommendations exists. Little is known about OA management provided by physiotherapists in Germany and whether treatment aligns with CPGs. The objectives of this study were (1) to investigate the current physiotherapy practice in patients with hip and/or knee OA in Germany, (2) to evaluate physiotherapists' adherence to guideline recommendations and (3) to explore barriers and facilitators to guideline use. Methods A cross-sectional online survey was conducted among physiotherapists. The questionnaire collected information on demographic characteristics, physiotherapists' management of hip and knee OA and the use of CPGs in clinical practice. Guideline adherence was evaluated by comparing the survey findings with guideline recommendations. Full adherence was assumed if all recommended treatment options were chosen. Results In total, 447 (74.9\%) of 597 eligible physiotherapists completed the survey. Data from 442 participants (mean age 41.2 ± 12.8 years; 288 female (65.1\%)) were included in the analysis. The most common treatment choices for both hip and knee OA were exercise therapy (hip OA: 424/442, 95.9\%; knee OA: 426/442, 96.4\%), self-management advice (hip OA: 413/442, 93.2\%; knee OA: 395/442, 89.4\%) and education (hip OA: 325/442, 73.5\%; knee OA: 331/442, 74.9\%), followed by manual therapy (hip OA: 311/442, 70.4\%; knee OA: 311/442, 70.4\%) and joint traction (hip OA: 208/442, 47.1\%; knee OA: 199/442, 45.0\%). Full guideline adherence was found in 17.2\% (76/442) of physiotherapists for hip OA management and in 8.6\% (38/442) for knee OA. Less than half of the respondents (212/430, 49.3\%) were aware of an OA guideline. Conclusions In accordance with current guideline recommendations, most physiotherapists provide exercise therapy and education for patients with hip and/or knee OA. Interventions with low or conflicting evidence were also frequently provided. The limited awareness of existing OA guidelines and the low guideline adherence indicate an insufficient implementation of CPGs in German physiotherapy practice.}, language = {en} } @misc{BahnsSchefflerKopkow, author = {Bahns, Carolin and Scheffler, Bettina and Kopkow, Christian}, title = {Guideline-Adherent Physiotherapy for Patients With Hip and Knee Osteoarthritis in Germany: Protocol for an Implementation Research Project Using the Theoretical Domains Framework and the Behavior Change Wheel}, series = {JMIR Research Protocols}, volume = {12}, journal = {JMIR Research Protocols}, issn = {1929-0748}, doi = {10.2196/47834}, abstract = {Background: Hip and knee osteoarthritis is common and leads to pain, stiffness, and disability. Clinical practice guidelines provide recommendations based on the best available evidence to assist health care professionals and patients in clinical decision-making. However, several studies have reported a gap between guideline recommendations and clinical practice in physiotherapy. Improved implementation strategies and the removal of existing barriers may facilitate the transfer of evidence into clinical practice and contribute to optimized quality of care. Objective: This paper presents the protocol for a study that aims to describe the current physiotherapy practice in patients with hip and knee osteoarthritis and to investigate physiotherapists' adherence to clinical practice guidelines, to identify and specify barriers to and facilitators of guideline use and implementation, and to develop and pilot test a theory-based tailored implementation intervention aiming to increase guideline use in osteoarthritis care. Methods: The research project is divided into 4 parts. During the first part, we will conduct a nationwide web-based survey among German physiotherapists to evaluate the current management of hip and knee osteoarthritis and to evaluate whether treatment aligns with guideline recommendations. Subsequently, semistructured interviews will be conducted to specify barriers to and facilitators of guideline use and implementation among physiotherapists (part 2). On the basis of these findings, in part 3, we will develop a theory-driven implementation intervention based on the Theoretical Domains Framework and the Behavior Change Wheel, which will be evaluated in a controlled pilot study in terms of effectiveness, feasibility, and acceptability (part 4). Results: Data collection of the web-based survey among German physiotherapists (part 1) was completed in December 2021. The semistructured interviews (part 2) were conducted between January and September 2023. Recruitment of physiotherapy practices to participate in the development of the implementation intervention is expected to start in January 2024. Conclusions: This research project aims to develop a theory-driven implementation intervention to facilitate the transfer of evidence from hip and knee osteoarthritis guidelines in physiotherapy practice. We hypothesize that successful implementation will lead to increased guideline adherence in physiotherapists, which in turn will improve the quality of care. The results from our project will provide valuable knowledge concerning the development process and effectiveness of tailored implementation interventions.}, language = {en} } @misc{WeberMuellerBahnsetal., author = {Weber, Franziska and M{\"u}ller, Carsten and Bahns, Carolin and Kopkow, Christian and F{\"a}rber, Francesca and Gellert, Paul and Otte, Ina and Vollmar, Horst Christian and Brannath, Werner and Diederich, Freya and Kloep, Stephan and Rothgang, Heinz and Dieter, Valerie and Krauß, Inga and Kloek, Corelien and Veenhof, Cindy and Collisi, Sandra and Repschl{\"a}ger, Ute and B{\"o}binger, Hannes and Gr{\"u}neberg, Christian and Thiel, Christian and Peschke, Dirk}, title = {Smartphone-assisted training with education for patients with hip and/or knee osteoarthritis (SmArt-E): study protocol for a multicentre pragmatic randomized controlled trial}, series = {BMC Musculoskeletal Disorders}, volume = {24}, journal = {BMC Musculoskeletal Disorders}, number = {1}, doi = {10.1186/s12891-023-06255-7}, abstract = {Hip and knee osteoarthritis are associated with functional limitations, pain and restrictions in quality of life and the ability to work. Furthermore, with growing prevalence, osteoarthritis is increasingly causing (in)direct costs. Guidelines recommend exercise therapy and education as primary treatment strategies. Available options for treatment based on physical activity promotion and lifestyle change are often insufficiently provided and used. In addition, the quality of current exercise programmes often does not meet the changing care needs of older people with comorbidities and exercise adherence is a challenge beyond personal physiotherapy. The main objective of this study is to investigate the short- and long-term (cost-)effectiveness of the SmArt-E programme in people with hip and/or knee osteoarthritis in terms of pain and physical functioning compared to usual care.}, language = {en} } @misc{PieperPachanovBahnsetal., author = {Pieper, Dawid and Pachanov, Alexander and Bahns, Carolin and Prill, Robert and Kopkow, Christian and Shehu, Eni and Song, Yang and Amer, Yasser Sami and Stein, Airton Tetelbom and Choi, Kyung-Eun Anna}, title = {Locally adapted guidelines: a scoping review}, series = {Systematic Reviews}, volume = {14}, journal = {Systematic Reviews}, number = {1}, publisher = {Springer Science and Business Media LLC}, issn = {2046-4053}, doi = {10.1186/s13643-025-02808-0}, pages = {1 -- 9}, abstract = {Background Clinical practice guidelines (CPGs) often fail to be fully implemented in practice. One barrier to CPG implementation is inconsistency between recommendations and existing practice patterns. This can include patients, personnel, structure, availability of resources, cultural and ethical values. To account for this, it is feasible to tailor national CPGs to a regional or local context (e.g. hospital). Local ownership can be beneficial and help to implement the guideline without affecting guideline validity. This process is also known as guideline adaptation. We aimed to identify randomized controlled trials (RCTs) investigating the effectiveness of locally adapted CPGs. Methods We performed a scoping review, following the JBI guidance. The scoping review was registered with the Open Science Framework (https://osf.io/3ed2w). The intervention had to be a locally adapted guideline (locally meaning adapted to any delineated area and/or entity at subnational and/or transnational level). Co-interventions were accepted. We did not restrict the control group. As we considered locally adapted guidelines as an intervention, and it seems feasible to test locally adapted guidelines in trials, we only considered RCTs, including cluster-RCTs. PubMed and Embase were searched in November 2024. Two reviewers independently screened titles and abstracts, full-text articles, and charted data. Conflicts were resolved by involving a third reviewer. Data were summarized descriptively. The findings were discussed with knowledge users. Results Five cluster RCTs reported in 8 publications and published between 2000 and 2010, were included. The trials originated from the UK, Scotland, Australia, the US, and the Netherlands. The adapted CPGs focused on diabetes, asthma, smoking cessation, mental disorders, and menorrhagia and urinary incontinence. The number of sites (e.g. practices) ranged from 4 to 30. Reporting was mostly insufficient to understand how adaptation was performed. Interventions always included some form of dissemination, such as educational meetings or workshops. Conclusions There is a lack of RCTs investigating the effectiveness of locally adapted guidelines. A systematic review is unwarranted due to the clinical and methodological heterogeneity of these trials. The identified studies were largely conducted over 20 years ago, highlighting a significant knowledge gap. The reasons for the lack of similar studies today are unclear, which is surprising given advances in adaptation frameworks in guideline development. As the importance of contextualization is emphasized, future studies on locally adapted guidelines should be conducted with strong rationale supported by local data. Without a sound rationale, there is a risk that evidence-based, high-quality guidelines could be undermined. In future trials, authors should closely adhere to reporting guidelines. Systematic review registration https://osf.io/3ed2w.}, language = {en} } @misc{BahnsNapieralaKompHaukeetal., author = {Bahns, Carolin and Napierala-Komp, Simone and Hauke, Jeannine and Strunk, Chiara Julia and Glaubitz, Andreas and Kopkow, Christian}, title = {Einfluss einer zweit{\"a}gigen Schulung auf das Wissen und die Sicherheit deutscher Physiotherapeut*innen in der Versorgung von H{\"u}ft- und Kniegelenksarthrose : eine Pr{\"a}-Post-Studie}, series = {Physioscience : Wissenschaft \& Forschung in der Physiotherapie}, journal = {Physioscience : Wissenschaft \& Forschung in der Physiotherapie}, number = {2}, publisher = {Georg Thieme Verlag KG}, address = {Stuttgart}, issn = {1860-3092}, doi = {10.1055/a-2437-9070}, pages = {1 -- 10}, abstract = {Hintergrund In Leitlinien wird Bewegungstherapie in Kombination mit Edukation zur Behandlung von Personen mit H{\"u}ft- und Kniegelenksarthrose empfohlen. Im Jahr 2013 wurde das Programm „Good Life with osteoArthritis in Denmark" (GLA:D) initiiert, das Patient*innen eine einheitliche evidenzbasierte Behandlung gew{\"a}hrleisten soll. Therapeut*innen m{\"u}ssen an einem zweit{\"a}gigen Kurs teilnehmen, in dem die Inhalte des strukturierten Edukations- und {\"U}bungsprogramms vermittelt werden. Ziel Untersuchung des Effekts der zweit{\"a}gigen Schulung auf das subjektiv wahrgenommene Wissen und die empfundene Sicherheit von Physiotherapeut*innen in der Versorgung von Personen mit H{\"u}ft- und Kniegelenksarthrose. Methode Physiotherapeut*innen nahmen unmittelbar vor und 2 Wochen nach der Schulung an einer Online-Befragung teil. Erfasst wurden u. a. das Vertrauen in die eigenen Kompetenzen zur Erbringung einer leitliniengerechten Therapie f{\"u}r Patient*innen mit Arthrose, das Wissen {\"u}ber Behandlungsempfehlungen sowie die Kenntnis von Leitlinien. Die Effektivit{\"a}t der Schulung wurde im Rahmen eines Vorher-Nachher-Vergleichs evaluiert. Ergebnisse Von 290 geschulten Physiotherapeut*innen nahmen 254 an der ersten Befragung teil (R{\"u}cklaufquote: 87,6 \%), darunter 114 Frauen (44,9 \%). Das Durchschnittsalter der Befragten betrug 35 Jahre (± 10,7). Insgesamt 83 Therapeut*innen (32,7 \%) verf{\"u}gten {\"u}ber einen akademischen Abschluss. Der zweite Fragebogen wurde von 85 Personen beantwortet (R{\"u}cklaufquote: 29,3 \%). Die Teilnahme an der zweit{\"a}gigen Schulung f{\"u}hrte zu positiven Ver{\"a}nderungen beim subjektiv wahrgenommenen Wissen und bei der empfundenen Sicherheit zur Durchf{\"u}hrung leitliniengerechter Therapie. {\"U}ber 98 \% der Befragten f{\"u}hlten sich nach dem Kurs dahingehend geschult und in der Lage, Trainingstherapie und Edukation gem{\"a}ß den aktuellen Leitlinien zu erbringen. Schlussfolgerung Die Teilnahme an der zweit{\"a}gigen GLA:D-Schulung f{\"u}hrte zu Verbesserungen beim subjektiv wahrgenommenen Wissen und bei der empfundenen Sicherheit von Physiotherapeut*innen zur Behandlung von Personen mit H{\"u}ft- und Kniegelenksarthrose. Diese Ergebnisse unterstreichen die Bedeutung gezielter Schulungsmaßnahmen zur Sicherstellung einer umfassenden Implementierung von Evidenz und Leitlinienempfehlungen in der klinischen Praxis. Studienregistrierung Deutsches Register Klinischer Studien (DRKS00 032 853)}, language = {de} } @misc{BahnsSchefflerBremeretal., author = {Bahns, Carolin and Scheffler, Bettina and Bremer, Alexander and Kopkow, Christian}, title = {Measuring guideline adherence in physiotherapy : a scoping review of methodological approaches}, series = {Journal of Evaluation in Clinical Practice}, journal = {Journal of Evaluation in Clinical Practice}, publisher = {Wiley}, issn = {1356-1294}, doi = {10.1111/jep.14218}, pages = {1 -- 10}, abstract = {RationaleClinical practice guidelines summarise the existing evidence on specific health conditions and aim to optimise quality of care by providing evidence-based recommendations. Studies have reported a gap between research findings and clinical practice in physiotherapy. Guideline adherence is often used as a measure of agreement between therapeutic care and guideline recommendations. However, there is currently no standardised methodological approach for measuring guideline adherence.Aims and ObjectiveThe objective of this scoping review was to summarise the methods and results of studies that assessed guideline adherence in physiotherapy.MethodsMEDLINE, EMBASE, PEDro and CENTRAL databases were searched for relevant literature up to December 2022. Published reports of observational studies and controlled clinical trials that provided information on the assessment of guideline adherence in physiotherapists were included. The selection process was performed independently by two reviewers. The methodological quality of the identified reports was not assessed. Results were summarised narratively.ResultsFrom a total of 2560 potentially relevant records, 53 reports were included in the analysis. Physiotherapists' adherence to guidelines was primarily assessed in the context of musculoskeletal conditions, such as low back pain (n = 25, 47.2\%) and osteoarthritis (n = 8, 15.1\%). A wide range of measurement approaches were used with the majority of reports using web-based surveys (n = 21, 39.6\%), followed by chart reviews (n = 17, 32.1\%). Most reports (n = 21, 39.6\%) provided information on the level of adherence in terms of frequency dichotomising (self-reported) clinical practice as adherent or non-adherent. Adherence rates varied widely between included reports.ConclusionsAlthough the large number of included reports indicates a high level of interest in the topic of guideline adherence, there is considerable heterogeneity between studies regarding the methodological approaches used to assess guideline adherence in physiotherapists. This reduces the comparability of the study results.Trial RegistrationINPLASY (registration no. 202250081). Registered on 12th May 2022.}, language = {en} }