National clinical guidelines in municipality-based rehabilitation: A cross-sectional survey of knowledge, use, and implementation

Background: Despite increasing research within physiotherapy, consistent implementation of evidence-based guidelines in everyday physiotherapy practice can present a challenge. Objective: To examine the knowledge, use, and implementation of National Clinical Guidelines (NCG) for knee arthrosis and meniscus pathology in municipality-based rehabilitation in Denmark. Methods: A cross-sectional survey using a web-based questionnaire developed for the present study. Respondents included rehabilitation unit managers, staff in charge of professional development and physiotherapists from municipality-based rehabilitation units in one of the Denmark’s five regions. Results: The questionnaire was completed by 61 respondents (75.3%). The responses indicated significantly better knowledge of the NCG for knee arthrosis than of the NCG for meniscus pathology (p = .017). Eighty-two percent (n = 50) replied that their unit had developed local guidelines for knee arthrosis; 74% (n = 45) for meniscus pathology. A total of 72% (n = 44) stated that relevant parts of the knee arthrosis NCG were integrated in local guidelines, whereas only 49% (n = 30) said the same for the meniscus pathology NCG. Respondents replied that implementation depends on factors such as time (46%, n = 28), knowledge (31%, n = 19), and the perceived relevance of the NCG (33%, n = 20) as well as support from local rehabilitation unit managers (23%, n = 14). Conclusion: Differences in the knowledge, use, and implementation of two NCGs among rehabilitation unit managers, staff in charge of professional development, and physiotherapists in municipality-based rehabilitation were identified. It seems that NCGs do not necessarily translate directly into local guidelines.