Preliminary results of the implementation of a new software-based clinical photographic posture assessment tool (CPPAT) in the clinic: Translating knowledge into practice

Introduction
Implementation of research results into clinical practice is essential to improve health services. Presently, there is a lack of evidence regardingthe effectiveness of physiotherapy interventions on posture. This may be due to the lack of evidence-based clinical methods to quantitatively assess posture. This study examines the implementation ofCPPAT in different clinical settings.

Objectives
1. To implement CPPAT for standardizing posture assessment in clinical practice. 2. To evaluate the success of the implementation by determining the practical usefulness and facilitators/barriers for its adoption.

Methods
We recruited 35 clinicians working in public or private institutions in Canada (Montréal, Québec, Edmonton), France (Lyon) and United Kingdom (London, Middlesbrough, Chesterfield). Inclusion criteria were clinicians assessing posture of persons with spinal disorders or posture impairments within their clinical routine and having access to a photographic set-up. Participants received a 4-5 hours training session for photographic acquisitions and data processing with the software program. To complete the training, participants had to use the software to assess the posture of 3 eligible patients (with spinal disorders or posture impairments). Following the training period, participants were asked to record how many cases were assessed with the tool and time spent for marker placement/acquisition of photographs and for data post-processing during a period of three months. After the trial period, participants completed a validated questionnaire. Domains assessed included Perceived ease of use (six items), Perceived usefulness (six items) and Intention to use (six items). Participants also commented on the advantages/disadvantages of theCPPAT and factors facilitating/inhibiting use of the tool.

Results and discussion
Preliminary results are reported for eight participants from Québec with half of them working in public institutions. Fifty percent of theparticipants found it easy to learn or interact with the tool. Seven of the eight (88%) participants indicated that the tool would be usefulto assess posture more accurately and objectively and to provide better evidence on their posture exams. Only two (25%) noted thatthe tool would increase their treatment performance/effectiveness. Fifty percent intended to continue using the tool. The principal facilitator was usefulness to quantify and provide evidence for posture assessment whereas the principal barriers were time required to dothe complete analysis of the posture indices and the skill required with the software program.

Conclusion and significance
The preliminary results on implementation in clinical practice indicate that the CPPAT is well perceived by clinicians and seen as useful if modifications were made to ease the use of the tool. The CPPAT should contribute to clinical practice by facilitating the quantitative analysis ofposture. Complete analysis of our cohort and of facilitators/barriers will help inform the promotion of CPPAT into clinical practice.