Barriers and Facilitators Influencing Physiotherapists’ Adherence to Clinical Practice Guidelines and Return to Sport Criteria after Anterior Cruciate Ligament Reconstruction: A Qualitative Study in Austria.
Abstract
Background Despite well-established clinical practice guidelines (CPGs) and return to sport (RTS) criteria following anterior cruciate ligament reconstruction (ACLR), adherence in clinical physiotherapy practice remains inconsistent. Suboptimal adherence may contribute to impaired rehabilitation outcomes and increased long-term knee morbidity. Hypothesis/Purpose The purpose of this study was to explore barriers and facilitators influencing Austrian physiotherapists’ adherence to CPGs and RTS criteria during rehabilitation after ACLR. Study Design Qualitative study. Methods Nine physiotherapists (mean professional experience 9 years; 78% sports-specialized) involved in ACLR rehabilitation participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis following Braun and Clarke’s framework. Results Four key themes describing barriers were identified: limited usability of ACLR CPGs, patient expectations and engagement, professional attitudes and resource limitations, and interprofessional misalignment. Facilitators included structured and transparent guidelines, ongoing professional development and resource availability, patient motivation and individualized training plans, and institutional support (e.g., insurance coverage). RTS criteria application varied, with some physiotherapists using structured testing batteries and others relying on individualized clinical judgment. Conclusion Physiotherapists’ adherence to ACLR CPGs and RTS criteria is influenced by guideline design, clinician factors, patient engagement, interdisciplinary dynamics, and institutional support. Addressing educational gaps, promoting reflective practice, enhancing guideline usability, and strengthening interdisciplinary communication could improve adherence and optimize rehabilitation outcomes following ACLR. Level of Evidence Level 3.