Selective acceptance of acute whiplash guidelines: a qualitative analysis of perceptions of health professionals in Australia

Abstract

Purpose

To explore health professionals’ acceptance of the guidelines for acute whiplash associated disorders (WAD), and to identify barriers and facilitators to adherence.

Materials and methods

Qualitative descriptive study involving focus group discussions among health professionals who treat people with WAD in primary and secondary care settings in New South Wales and Queensland, Australia. Twenty-eight health professionals (physiotherapists = 19; chiropractors = 6; osteopaths = 3) participated in six semi-structured focus group discussions that were held in independent offices in Sydney and Brisbane, Australia between September and December 2015. Discussions were audio recorded and verbatim, de-identified transcripts produced. Thematic analysis was conducted using an inductive approach to identify commonly held beliefs.

Results

Acceptance of guideline recommendations appeared to be influenced by factors related to the guideline itself, practitioner and practice characteristics, and patient-related factors. Specifically, acceptance was hindered by conflicting belief systems, ambiguity in guideline recommendations, and patient characteristics and expectations.

Conclusions

Practitioners demonstrated a positive attitude towards the use of the guidelines in general; however, in some cases, acceptance of key recommendations appeared selective. Future guideline revision and implementation might focus on explaining the underlying principles of the guidelines, providing more detailed recommendations, and involving strategies that challenge inconsistent beliefs and promote informed decision-making.

IMPLICATIONS FOR REHABILITATION

• Selective acceptance of guideline recommendations in favour of those not requiring practice change may present a challenge for the implementation of evidence-based practice in the management of whiplash.

• Participants demonstrated variable, sometimes polar attitudes to guideline key messages and recommendations.

• Guideline developers need to focus more strongly on changing practitioner beliefs and attitudes, as well as better explaining the underlying principles of the guidelines, and providing more detailed recommendations.

Keywords:

• Guideline adherence
• primary health care
• whiplash injuries
• focus groups
• barriers and facilitators

Acknowledgements

The research team would like to acknowledge the support of the University of Sydney Musculoskeletal Laboratory, Chiropractors Association of Australia, Australian Physiotherapy Association, and the Central and Eastern Sydney Primary Health Network in promoting the study. ANB was supported by scholarships from the University of the Philippines Expanded Modernization Program—Doctoral Studies Fund and the University of Sydney Non-established Post-graduate Award. TR was supported by an NHRMC Career Development Research Fellowship and a University of Sydney SOAR Fellowship.

Ethical approval

Ethics approval for the study was given by The University of Sydney (Protocol No: 2015-444) and Griffith University (Protocol No: 2015-707) Human Research Ethics Committees. All participants provided informed consent before participation, including consent for audio-recording of the discussions and publication of de-identified data.

Roles of authors

The authorship team are whiplash researchers from the physiotherapy and exercise physiology disciplines who are also educators (TR, AL, MM, ANB, MS, and CR) and clinicians (TR, AL, JK, and ANB). The senior researchers were contributing authors of the original NSW State Insurance Regulatory Authority WAD guidelines (TR and AL) and the QLD Motor Accident Insurance Commission and the University of Queensland Whiplash Injury Self-help Guide (MS). The team has conducted extensive research in collaboration with the NSW and QLD motor accident insurance scheme regulators in relation to the implementation and evaluation of WAD guidelines. The author's assumptions include advocacy for evidence-based practice in the management of WAD.

Author contributions

ANB contributed to study design, ethics application, data collection, analysis, and interpretation of data, and drafted and revised the manuscript for this study. AL contributed to study design, data collection, analysis and interpretation of data, and revision of the manuscript for important intellectual content. MS and TR conceived the study, obtained the funding, and were involved in study design, data collection, and critical appraisal and revision of the manuscript for important intellectual content. MM, CR, and JK contributed to the study design, data collection, and critical appraisal and revision of the manuscript for important intellectual content. All authors agreed on the final version of the manuscript for publication and agree to be accountable for all aspects of the work, including the accuracy and integrity of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by funding from the State Insurance Regulatory Authority of NSW and the Motor Accident Insurance Commission of QLD. The funding sources were not involved in any aspect of the study (design, data collection, analysis and interpretation of data, writing and review of the manuscript).