Qualitative Evaluation Of Blood Flow Restriction Implementation In Rehabilitative Settings

There is a large body of research investigating the effects of blood flow restriction (BFR). Alone, BFR attenuates disuse muscular atrophy, combined with low-intensity endurance training it improves cardiorespiratory fitness, and combined with low-load resistance training it improves muscle size. However, much less is known about factors influencing a clinician’s decision to apply BFR. PURPOSE: To identify factors influencing clinicians’ implementation of BFR in rehabilitative settings. METHODS: 5 athletic trainers, 4 physical therapists, and 1 occupational therapist were interviewed. Qualitative semi-structured interviews, addressing 12 implementation constructs within four domains (intervention characteristics, outer setting, inner setting, and characteristics of individuals), were developed from the Consolidated Framework for Implementation Research interview guide. Questions were adapted to inquire about the implementation of BFR specifically. Interviews were conducted via teleconference, transcribed, then evaluated. Each construct was rated, from -2 to +2, according to the Consolidated Framework for Implementation Research rating rules to determine whether they had a positive, negative, or neutral influence on clinicians’ implementation of BFR. RESULTS: Constructs positively influencing BFR implementation were evidence strength and quality (+2), access to knowledge and information (+2), and knowledge and beliefs about the intervention (+2). Constructs negatively influencing implementation were adaptability (-1), cost (-2), and available resources (-2). Neutral constructs (all rated 0) were intervention source, relative advantage, complexity, patient needs and resources, culture, and self-efficacy. External policies and incentives, and networks and communications emerged as 2 constructs that potentially influence BFR implementation, but they were not rated due to a lack of direct investigation. CONCLUSION: Clinicians’ implementation of BFR in rehabilitative settings was most positively affected by their belief in its effectiveness, evidence supporting its effectiveness, and their access to information about BFR. However, the cost and time/space requirements associated with the use of BFR may outweigh other factors and inhibit its implementation.