The impact of a tailored, theoretically driven implementation strategy on the uptake of evidence: Integrating the Balance Intensity Scale into clinical care

Background: While many physiotherapists have a positive attitude towards evidence-based practice, barriers to evidence implementation are present. The Theoretical Domains Framework (TDF) identifies influences on implementation behaviour, which can be used to design implementation strategies. The Balance Intensity Scale (BIS) is the first validated objective measure of balance exercise intensity. This tool supports the prescription and measurement of balance exercises, essential for improving balance and reducing falls. This study aimed to establish the barriers and enablers to clinical use of the BIS and the impact of tailored implementation intervention.

Method: Mixed-methods study utilising the Theoretical Domains Framework, including (a) a pre-implementation survey; (b) a repeat post-implementation survey; and (c) a post-implementation focus group.

Results: Pre-implementation study (n=24) findings informed the design of a BIS implementation intervention. Key strategies included specific education, accessibility of the BIS in clinical spaces, change champions, and environmental reminders. Post-implementation survey (n=12) demonstrated enhanced Knowledge (p = 0.040), Skills (p = 0.003) and Beliefs in capabilities (p = 0.030) in the prescription and measurement of balance exercises. Focus group (n=7) findings identified the importance of supporting the team, social supports, ensuring new evidence is theoretically sound, easily accessible resources, and respect for implementation time.

Discussion: This project demonstrates the value of a tailored, theoretically driven approach to allied health implementation, while acknowledging that barriers will continue to exist. It provides a model that can be used in different contexts and by different professions when seeking to implement evidence-based practices in routine clinical care.