Abstract：
BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a common presentation to the ED. Evidence suggests low adherence to guideline-recommended care, but the reasons underlying this are poorly understood. This study used the theoretical domains framework (TDF) to explore the barriers and facilitators to medical and physiotherapy clinical practices in the management of BPPV in an Australian metropolitan ED.
METHODS: From May to December 2021, semistructured interviews were conducted with 13 medical staff and 13 physiotherapists who worked at an ED in Melbourne, Australia. Interviews used the TDF to explore the perceived barriers and facilitators to the delivery of guideline-recommended assessment and treatment techniques for BPPV. Data were analysed thematically to identify relevant domains and generate themes and belief statements.
RESULTS: Fifteen belief statements representing eight domains of the TDF were identified as key factors in the management of BPPV in the ED. The most prominent domains were knowledge and skills due to their conflicting belief statements between professions concerning education, skill development and self-confidence; memory, attention and decision processes for the perceived complexity of the presentation including difficulty recalling diagnostic and treatment techniques; and environmental context and resources for their shared belief statements concerning time and workload pressures. The availability of vestibular physiotherapy was considered both a barrier and facilitator to the delivery of recommended care by medical staff, but a barrier to independent practice as it unintentionally limited the opportunities for skill development in medical staff.
CONCLUSIONS: Several modifiable barriers and facilitators to the management of BPPV in the ED have been identified. Differences were observed between the professional groups, and these findings will guide a future intervention to improve the use of guideline-recommended assessment and treatment techniques for BPPV in ED.
METHODS: From May to December 2021, semistructured interviews were conducted with 13 medical staff and 13 physiotherapists who worked at an ED in Melbourne, Australia. Interviews used the TDF to explore the perceived barriers and facilitators to the delivery of guideline-recommended assessment and treatment techniques for BPPV. Data were analysed thematically to identify relevant domains and generate themes and belief statements.
RESULTS: Fifteen belief statements representing eight domains of the TDF were identified as key factors in the management of BPPV in the ED. The most prominent domains were knowledge and skills due to their conflicting belief statements between professions concerning education, skill development and self-confidence; memory, attention and decision processes for the perceived complexity of the presentation including difficulty recalling diagnostic and treatment techniques; and environmental context and resources for their shared belief statements concerning time and workload pressures. The availability of vestibular physiotherapy was considered both a barrier and facilitator to the delivery of recommended care by medical staff, but a barrier to independent practice as it unintentionally limited the opportunities for skill development in medical staff.
CONCLUSIONS: Several modifiable barriers and facilitators to the management of BPPV in the ED have been identified. Differences were observed between the professional groups, and these findings will guide a future intervention to improve the use of guideline-recommended assessment and treatment techniques for BPPV in ED.
摘要：
背景：良性阵发性位置性眩晕（BPPV）是ED的常见表现。证据表明，对指南推荐护理的依从性低，但是对此的原因却知之甚少。这项研究使用理论领域框架（TDF）来探索澳大利亚大都市ED中BPPV管理中医学和物理治疗临床实践的障碍和促进因素。
方法：从2021年5月至12月，对在墨尔本急诊室工作的13名医务人员和13名物理治疗师进行了半结构化访谈，澳大利亚。访谈使用TDF来探索BPPV指南推荐的评估和治疗技术的感知障碍和促进者。对数据进行了主题分析，以确定相关领域并生成主题和信念陈述。
结果：代表8个TDF领域的15个信念陈述被确定为ED中BPPV管理的关键因素。最突出的领域是知识和技能，因为它们在有关教育的职业之间的信仰陈述相互矛盾，技能发展和自信；记忆，注意和决策过程，以感知演示文稿的复杂性，包括难以回顾诊断和治疗技术；以及环境背景和资源，以用于他们关于时间和工作量压力的共同信念陈述。前庭理疗的可用性被认为是提供医务人员推荐护理的障碍和促进者。但这是独立实践的障碍，因为它无意中限制了医务人员技能发展的机会。
结论：已经确定了ED中BPPV管理的几个可修改的障碍和促进因素。观察到专业群体之间的差异，这些发现将指导未来的干预措施,以改善ED中BPPV指南推荐的评估和治疗技术的使用.
方法：从2021年5月至12月，对在墨尔本急诊室工作的13名医务人员和13名物理治疗师进行了半结构化访谈，
结果：代表8个TDF领域的15个信念陈述被确定为ED中BPPV管理的关键因素。
结论：已经确定了ED中BPPV管理的几个可修改的障碍和促进因素。
