{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T18:51:14Z","timestamp":1792349474003,"version":"4.4.0"},"reference-count":19,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exercise\u2010based physiotherapy is recommended as a core component of haemodialysis care; however, its implementation in routine clinical practice remains inconsistent. While intervention fidelity is considered essential for ensuring evidence\u2010based practice, little is known about how physiotherapists adapt rehabilitation protocols in response to the complexities of real\u2010world clinical environments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore how physiotherapists balance intervention fidelity with contextual adaptation during haemodialysis rehabilitation and to examine the cognitive, social, and contextual factors influencing clinical decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative interpretive study was conducted across four haemodialysis centres using semi\u2010structured interviews with 16 physiotherapists. Participants were recruited through purposive maximum\u2010variation sampling to capture diverse clinical experiences and practice settings. Data were analyzed using reflexive thematic analysis, with findings subsequently interpreted through the Mindlines model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four interrelated themes were identified: Safety Overrides Protocol, Experience as the Primary Guide, Context Shapes Practice, and Guidelines as Flexible References, which collectively informed the overarching theme of Adaptation as Skilled Practice. Physiotherapists consistently prioritised patient safety by modifying interventions according to physiological status and individual patient needs. Clinical decisions were informed by experiential knowledge, interprofessional interactions, and organisational constraints, with guidelines serving as flexible reference points rather than prescriptive rules. The findings demonstrate that context\u2010sensitive adaptation represents deliberate clinical reasoning rather than simple protocol non\u2010adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Intervention fidelity in haemodialysis physiotherapy should be understood as a dynamic process that accommodates appropriate contextual adaptation while preserving the core intent of rehabilitation. Recognizing adaptive clinical expertise may strengthen the implementation of evidence\u2010based physiotherapy in complex healthcare settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70689","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T18:30:27Z","timestamp":1792348227000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When Deviation Is Necessary: Balancing Intervention Fidelity and Contextual Adaptation in Haemodialysis Physiotherapy"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4895-9141","authenticated-orcid":false,"given":"Santosh P.","family":"Dobhal","sequence":"first","affiliation":[{"name":"Department of Cardiovascular &amp; Respiratory Physiotherapy MGM Institute of Physiotherapy Chhatrapati Sambhaji Nagar Maharashtra India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7416-4663","authenticated-orcid":false,"given":"Manish Prannath","family":"Shukla","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular &amp; Respiratory Physiotherapy Datta Meghe College of Physiotherapy Nagpur Maharashtra India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4097-5342","authenticated-orcid":false,"given":"Abhishek","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular &amp; Respiratory Physiotherapy MGM Institute of Physiotherapy Chhatrapati Sambhaji Nagar Maharashtra India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5613-4406","authenticated-orcid":false,"given":"Ira","family":"Indurkar","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular &amp; Respiratory Physiotherapy Datta Meghe College of Physiotherapy Nagpur Maharashtra India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta25400"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2016030378"},{"key":"e_1_2_10_3_2","doi-asserted-by":"crossref","unstructured":"Erratum in: J Am Soc Nephrol. 2018 Jul;29(7):2028 doi:\u00a010.1681\/ASN.2018040439.","DOI":"10.1681\/ASN.2018040439"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9010043"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2024.117594"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.03170707"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-021-02618-1"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfad116"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40620-024-02049-9"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0309798"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtumed.2022.11.004"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7473.1013"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1628806"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/life16020340"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-020-02162-4"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.4068\/cmj.2011.47.2.61"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.7860\/JCDR\/2023\/62787.18777"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/10669817.2025.2577670"}],"container-title":["Journal of Evaluation in Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.70689","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jep.70689","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.70689","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T18:30:29Z","timestamp":1792348229000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jep.70689"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":19,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/jep.70689"],"URL":"https:\/\/doi.org\/10.1111\/jep.70689","archive":["Portico"],"relation":{},"ISSN":["1356-1294","1365-2753"],"issn-type":[{"value":"1356-1294","type":"print"},{"value":"1365-2753","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-04-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70689"}}