# Physical Therapists’ Use of Behavior Change Strategies to Promote Physical Activity for Individuals with Neurological Conditions

## TL;DR

Physical therapists working with neurological patients focus on home exercises but rarely use strategies to promote aerobic activity or behavior change.

## Contribution

This study characterizes how physical therapists use behavior change techniques to promote physical activity in neurorehabilitation.

## Key findings

- Home exercise programs are emphasized over aerobic activity in PA promotion.
- Common BCTs include instruction, behavioral practice, and social support.
- Factors like knowledge, beliefs, and environment influence BCT use.

## Abstract

Background/Objectives: People living with neurological conditions are inactive despite widespread literature showing physical activity (PA) is beneficial for this population. To impact long term changes in PA behavior, physical therapists treating individuals with neurological conditions need to provide effective PA promotion in combination with behavior change techniques (BCTs). The purpose of this study is to (1) characterize the use of BCTs during neurorehabilitation, and (2) to gain an understanding of considerations related to PA promotion. Methods: Observations of outpatient physical therapy encounters with subsequent semi-structured interviews were conducted. Observations were transcribed with detailed field notes and analyzed with descriptive analysis and deductive coding. Interviews were analyzed with thematic analysis. Results: Observations indicated that PA promotion in neurorehabilitation practice emphasizes home exercise programs, with less focus on aerobic activity. The most common BCTs used were instruction on how to perform the behavior, behavioral practice and rehearsal, and social support. Primary themes that impacted physical therapist use of BCTS for PA promotion included knowledge, decision processes, perceived role, beliefs, environmental context, and social influences. Conclusions: PA promotion from physical therapists in neurorehabilitation is not targeting activity guidelines and there is uncertainty about using behavior change strategies and PA guidelines for PA promotion.