Exploring Barriers and Facilitators to Implementation of Acute Care Physical Therapy in Obstetrics

Purpose: Complications of birth may result in impairments like those typically treated by inpatient acute care physical therapists. Research suggests that acute obstetric physical therapy within 24 to 48 hours of delivery improves patient outcomes; however, acute care physical therapy is rarely utilized in obstetrics. The barriers and facilitators of widespread implementation of acute obstetric physical therapy are unknown. The purpose of this study was to elucidate these barriers and facilitators among acute care physical therapists and physicians who practice in labor and delivery. Methods: A survey measuring factors related to the implementation of acute obstetric physical therapy was administered to 197 physical therapists and 18 physicians. Score distributions for barriers and facilitators were calculated as the number and percentage of respondents. Between-group differences in score distributions were calculated using Wilcoxon signed-rank tests. Results: Organizational support and inadequate physical therapist staffing were the barriers with the highest agreement in both groups. Obstetric and non-obstetric physical therapists did not differ in agreement for inadequate physical therapist staffing, patient insurance status impact, or robustness of pelvic health physical therapy referral network, but all other factors demonstrated significant differences ( P < .05, all). Physicians who have heard of acute obstetric physical therapy significantly differed from those who have not heard of this for organizational support (Z = 2.37, P = .02) and presence of staff outpatient pelvic health physical therapists (Z = 2.23, P = .01). Discussion: Current acute obstetric physical therapists perceive fewer barriers and may be champions for organizational change. Understanding the best implementation strategies via barriers and facilitators is essential for the delivery of optimal care without overburdening providers.