Empowering Physical Therapists to Address Their Patient’s Inadequate Physical Activity

TL;DR

This paper introduces a new approach to help physical therapists assess and address low physical activity in older adults, using a structured implementation plan.

Contribution

The study introduces a novel implementation plan combining PAVS and BAP to increase PTs' engagement in addressing physical activity in older adults.

Findings

Training increased PTs' knowledge and confidence in addressing physical activity (p < 0.001).

Three months into the project, 50% of PTs used PAVS and 25% completed BAP with over 25% of patients.

Abstract

One in ten older adults are inadequately active, doubling their falls and frailty risk. Despite this, 65% of physical therapists (PTs) do not assess or address patients’ physical activity (PA). We are addressing this gap by implementing the Physical Activity Vital Sign (PAVS) and Brief Action Planning (BAP), an evidence-based behavior change technique. Our work is guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. In the exploration phase, 51 PTs completed a needs assessment that examined potential implementation determinants, including: 1) individual capability and opportunity; 2) PAVS and BAP’s characteristics; 3) clinic culture and infrastructure; and 4) health system’s attitudes and partnerships. During the preparation phase, an implementation team consisting of PTs, clinic supervisor, older adults, and principal investigator co-developed an implementation plan that aims to address three barriers identified in the needs analysis and prioritized based on feasibility and importance. These barriers are lack of knowledge, confidence, and documentation infrastructure. The plan includes training, audit and feedback, site champions, facilitation, and electronic health record-based implementation strategies. We are evaluating the plan in an outpatient physical therapy clinic, where 20 PTs are participating in a year-long implementation pilot. Using a pre-post knowledge assessment and a confidence rating, we identified that our training increased PTs’ knowledge and confidence in assessing and addressing inadequate PA (p < 0.001). Three months into the project, 50% of PTs used the PAVS and 25% completed BAP with >25% of older adult patients. Currently, the implementation team is refining strategies to further increase the adoption rates.