Abstract
Background:
Local pilot findings indicate that a group therapy care model may improve clinical outcomes and patient experience among young athletes after anterior cruciate ligament reconstruction (ACLR). The purpose of this qualitative study was to elucidate physical therapist perspectives associated with implementing a group therapy model during mid-stage rehabilitation (3-7 months post-ACLR).
Hypothesis:
This study sought to explore the primary research question, “what facilitators and barriers exist to real-world implementation of a group therapy care model for youth after ACLR?”
Methods:
Nine sports medicine physical therapists from a large pediatric medical center (8.2 ± 6.6 years of professional experience; range: 1-19 years) were recruited to participate in clinician-specific semi-structured focus groups during the first phase of a larger implementation study. Interview question development was guided by the Consolidated Framework for Implementation Research (CFIR). Data collection focused on the physical therapists’ lived experiences related to care delivery for young athletes after ACLR. Using interpretive phenomenological methodology, focus groups were conducted, recorded, and transcribed verbatim. Thematic analyses were guided by the constant comparative method, allowing for identification of themes from open and axial coding. All coded data was used to develop a final thematic structure of clinician perspectives.
Results:
Facilitators of implementation were organized into 3 domains: (1) Population Alignment, reflecting the model’s strong fit with the holistic needs of youth after ACLR; (2) Team Culture of Buy-In, highlighting clinician identity and shared commitment to innovation; and (3) Institutional Backing, denoting perceptions of supportive infrastructure, leadership, and innovation culture within the institution. Key barriers to implementation were organized into 4 domains: (1) Slow Gears of Change, describing the challenges of navigating institutional inertia and adoption processes; (2) Logistics in Limbo, referring to uncertainties around staffing, scheduling, and group therapy billing; (3) Uneven Playing Field, pointing to population-specific barriers such as transportation access and narrow inclusion criteria; and (4) Strategic Drift, reflecting a perceived shift away from patient-centered outcomes due to productivity pressures. A set of 5 barrier-facilitator pairs emerged.
Conclusion:
As key stakeholders in the implementation of a novel group therapy care model, physical therapists describe context-specific factors perceived to facilitate or hinder swift transition of this promising care model from research to clinical practice. Future work will leverage this knowledge in combination with perspectives from all stakeholders for the successful design and implementation of a group therapy care model for youth after ACLR.