Implementing STEADI for routine falls prevention of all older adults attending outpatient physical therapy: key partner perspectives

TL;DR

This study explores how to implement a falls prevention program in outpatient physical therapy for older adults, identifying barriers and facilitators from key stakeholders.

Contribution

The study provides new insights into implementing the STEADI falls-prevention initiative in outpatient physical therapy settings.

Findings

Participants found STEADI acceptable, appropriate, and feasible for integration into routine outpatient PT.

Barriers included time constraints and limited familiarity with STEADI among therapists.

Physicians supported STEADI but expressed concerns about scope of practice and communication challenges.

Abstract

Falls are a leading cause of morbidity and mortality among older adults. Despite Prevention initiatives have been researched primarily in medical care. There is a dearth of studies on falls prevention in other primary care settings, such as outpatient physical therapy (PT). The purpose of this exploratory mixed methods study was to identify key partners' perceived barriers and facilitators to implementing the CDC's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) falls-prevention initiative as routine care for older adults receiving outpatient PT.

Using a sequential explanatory mixed methods design, we collected surveys assessing familiarity, acceptability, appropriateness, and feasibility of STEADI and falls prevention, followed by semi-structured interviews to explore barriers and facilitators. Participants included physical therapy providers (n = 16), physicians (n = 5), administrative staff (n = 3), patients (n = 10), and care partners (n = 10). Quantitative data were summarized descriptively, and qualitative data were analyzed using rapid thematic analysis mapped to the Consolidated Framework for Implementation Research 2.0.

Participants found STEADI acceptable, appropriate, and feasible for integration into routine outpatient PT. Barriers among therapists included time constraints and limited familiarity with STEADI while interest in learning and implementing STEADI and perceived compatibility were facilitators. Physicians supported therapists but expressed concerns about scope of practice and challenges with communication jargon. Administrative staff were willing to assist patients with screening. Patients and care partners were receptive to STEADI but anticipated that some older adults might resist participation.

Findings support the potential feasibility of implementing STEADI in outpatient physical therapy. Addressing provider education, workflow, and interdisciplinary collaboration can address barriers. Aligning STEADI with therapists' scope of practice, improving interprofessional communication, and raising public awareness of physical therapists' role in falls prevention are critical for adoption. Our findings will inform co-development of implementation strategies to address barriers and capitalize on facilitators to support STEADI adoption in outpatient physical therapy.

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