Part 1: Shared decision making in physical therapy: eliciting the patient agenda Part 2: Implementation of a Physical Therapy Approach Coach2Move for Older Adults: Barriers and Facilitators

Abstract

Background: There is ongoing study to the implementation of a cost-effective personalized approach to physical therapy (Coach2Move) in daily practices. Society is facing an enormous growth in the number of older adults with mobility problems related to activities of daily living. For transition from “care to illness to healthy behavior” we need professionals who empower patients to take responsibility for their own health. Aim: To identify which barriers and facilitators physical therapists experienced during the implementation of the Coach2Move physical therapy for the management of community-dwelling older adults (>=70 years) with mobility problems and/or physically inactive lifestyles in a pragmatic, real-world setting. Method: A qualitative study investigated the barriers and facilitators of the implementation of Coach2Move in sixteen various practices. Twelve random semi-structured interviews (30-90 minutes) were held with five physical therapists (PT) and seven physical therapists specialized in geriatrics (PTG). An interview protocol was developed. Each interview was audio¬taped and transcribed verbatim. Data were analyzed using a structured thematic approach ATLAS.ti. Results: The participating PTs and PTGs identified several barriers and facilitators regarding to the implementation of the Coach2Move program. Four themes emerged from these barriers and facilitators during data analysis. First, we found that the therapists in the trial struggled with applying the eligibility criteria. Especially people who had cognitive impairments or were less motivated were erroneously excluded. Second, the therapists positively experienced the Coach2Move training, despite the attendees had different levels of professional degrees. More emphasis could had been put on the eligibility criteria. Third, for a sustainable implementation of Coach2Move, all therapists deemed structural reimbursement of Coach2Move program by all health insurers as crucial and there has to be a continuous influx of new patients. Fourth and final, we found that the research context influenced the implementation of Coach2Move, both negatively as well as positively. Conclusion and key findings: Barriers and facilitators were identified in this study such as reimbursement by health insurance companies and the use of one EPD to make Coach2Move user-friendly. Before implementing Coach2Move into the field those barriers and facilitators should be taken into account.