Facilitators and barriers to implementing the CPAx-Nor in intensive care units: a qualitative study.

Abstract

Intensive Care Unit-Acquired Weakness and Post-Intensive Care Syndrome are common among critically ill patients, substantially impairing quality of life after discharge. Intensive Care Unit rehabilitation has been shown to mitigate these outcomes, and physiotherapists contribute by systematically assessing patient progress using standardized measurement tools such as the Norwegian version of Chelsea Critical Care Physical Assessment Tool (the CPAx-NOR). However, implementing such tools in intensive care settings is often challenging. This study explored the perceived applicability of the CPAx-NOR and examined facilitators and barriers to its use in Norwegian ICUs. A qualitative exploratory design was applied. Three focus group interviews were conducted with ten physiotherapists, one physician, one nurse, and one former ICU patient recruited from five Norwegian hospitals. Data collection was guided by a semi-structured interview guide. The Consolidated Framework for Implementation Research informed the thematic analysis. Participants perceived the CPAx-NOR as being well aligned with physiotherapy practice, adaptable to ICU rehabilitation, and important when developing a shared professional language within multiprofessional teams. Barriers included tension for change, difficulties in grip strength assessment, organizational constraints, and concerns about professional autonomy. The identified facilitators and barriers highlight the need for tailored implementation strategies to promote successful implementation of the CPAx-NOR in Norwegian ICUs.