Inspiratory muscle training for people with spinal cord injury: An implementation study.

Only three spinal units, 21 physiotherapists and 68 patients were involved, and the authors themselves say the study would have been stronger with more sites, therapists and patients. Implementation strategies were delivered for just six weeks, which the authors note may not have been long enough to hold the behaviour change. Adherence to the implementation strategies was not measured, so the reasons for the drop in provision at follow-up are only hypothesised. No second round of interviews after follow-up was done, so the barriers to sustaining the change were not explored. The effect of any single strategy cannot be separated, because audit feedback, education and the clinical champion were delivered together as one package.

The authors declared no potential conflicts of interest. The clinical practice guideline used in the study was funded by icare NSW, National Injury Insurance Scheme Queensland, Transport Accident Commission Victoria and Lifetime Support Authority South Australia, and open access funding was provided by CAUL and its Member Institutions.

Do not read the 91% post-implementation figure as a lasting change. Two months after support ended, provision had already fallen to 72%, so the gain was not sustained without ongoing audit feedback.