Evidence-based clinical guidelines are available for many common conditions in physiotherapy, providing structured recommendations for diagnostics and treatment. In the field of Urinary Incontinence in women (UI), several professional associations have developed guidelines to support healthcare professionals in delivering conservative, pharmacological, and surgical management strategies. These guidelines aim to synthesize current evidence into practical recommendations for typical patient populations (1). 
Despite the availability of freely accessible evidence-based guidelines (2) (3), their integration into physiotherapeutic practice remains inconsistent, and awareness among physiotherapists appears variable.
This original study aims to investigate the factors influencing the use of, and barriers to, the implementation of guideline recommendations in the physiotherapeutic management of UI in women in Austria.

In this qualitative study, an online survey was conducted in spring 2025 among 54 Austrian physiotherapists. Data was collected using a questionnaire comprising both closed and open-ended questions. The closed items were only used to describe the sociodemographic and professional characteristics of the sample. The open-ended questions aimed to explore participants’ perspectives in greater depth. This qualitative section of the questionnaire was structured into two parts to capture the experiences and evaluations of both guideline users and non-users.
IBM SPSS Statistics was only used to analyze demographic data. To address the research question, the qualitative data were analyzed using qualitative content analysis with inductive category development according to Mayring.

The results indicate both facilitators and barriers to the integration of clinical guidelines for UI in women in physiotherapeutic practice in Austria. Some physiotherapists highlighted the scientific evidence base and the orientation provided by guidelines as key advantages. The main barriers identified were a lack of knowledge about available guidelines and time constraints. Additional challenges included the perceived lack of individuality and specificity concerning a concrete treatment approach including repetitions and intensity within guideline recommendations. Notably, some participants who reported not using guidelines in their practice nevertheless applied individual elements of them, suggesting partial and often implicit implementation in clinical work.

The findings indicate that the use of clinical guidelines in the physiotherapeutic management of women with UI in Austria is shaped by both facilitating factors and barriers. Physiotherapists value the evidence-based foundation of guidelines and the structured guidance they provide for clinical decision-making, particularly for less experienced practitioners. Even highly experienced physiotherapists may benefit from regularly updated recommendations.
However, implementation is limited by insufficient awareness and time constraints in daily practice. To enhance knowledge and utilization, greater emphasis on clinical guidelines could be integrated into bachelor’s degree curricula. A key challenge identified is the discrepancy between the general, theoretical nature of guidelines and the perceived need for highly individualized, flexible, and adaptable patient care. Participants expressed a desire for more detailed guidance on specific therapeutic interventions, including parameters such as intensity and dosage.
While some physiotherapists reported applying guideline recommendations without being able to explicitly name specific guidelines, others relied on continuing education courses in which guideline content is conveyed. Continuing education providers appear to reference and integrate guideline recommendations into their teaching materials.
The study is limited by a small sample size (n = 54) and a low response rate (25.6%) with a high dropout rate (48.6%), which restricts generalizability. Therefore, the results reflect only indicative trends. While expert interviews could have provided deeper insights, they would have reduced the breadth of perspectives.

Overall, these findings highlight a generally positive attitude toward clinical guidelines for UI in women among physiotherapists, alongside persistent practical and educational barriers to their consistent and explicit implementation in clinical practice. Strengthening guideline awareness, improving accessibility, and providing more concrete, practice-oriented recommendations may support their more effective integration into physiotherapeutic care.

Sussman, R. D., Syan, R., & Brucker, B. M. (2020). Guideline of guidelines: urinary incontinence in women. BJU international, 125(5).
(NICE), N. I. f. H. a. C. E. (2019). Urinary incontinence and pelvic organ prolapse in women: management.
DGGG, OEGGG, & SGGG. (2021). Harninkontinenz der Frau.