在物理治疗师的实践中,针对社区居住的行动不便的老年人实施有效的 Coach2Move 方法:多方法过程评估》。

IF 3.5 4区 医学 Q1 ORTHOPEDICS Physical Therapy Pub Date : 2024-11-01 DOI:10.1093/ptj/pzae093
Ward Heij, Lieke Sweerts, J Bart Staal, Philip J van der Wees, Anne Thackeray, Maria W G Nijhuis-van der Sanden, Thomas J Hoogeboom
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引用次数: 0

摘要

研究目的本研究旨在评估 Coach2Move 方法的采用情况和忠实度;确定老年医学专业物理治疗师和非专业物理治疗师之间的差异;探讨采用水平和专业是否能解释有效性差异;以及探讨实施态度和经验方面的群体差异:通过 2 个教育日、3 次同行评估会议和改编的电子健康记录,对 Coach2Move 的实施过程进行了多方法评估,同时还进行了分组随机阶梯试验,将常规护理理疗与 Coach2Move 进行了比较。参与试验的有 36 名专业物理治疗师(n = 17)和非专业物理治疗师(n = 19),他们为 292 名社区老年人提供治疗。通过比较实施前的得分和实施一年后的得分,对采用水平和忠实度进行了分析。Coach2Move 的采用率通过电子评估得分来衡量,忠实度则通过健康记录指标来衡量。采用混合模式方差分析检验了专业化和采用对健康结果的影响。在半结构化访谈的基础上,通过调查收集了治疗师的态度和经验:结果:电子评估(采用 Coach2Move 思维模式)的平均指标总分从基线的 17%(SD = 5%)增加到随访时的 47%(SD = 9%)。具有老年病学专业的物理治疗师的得分高于不具有老年病学专业的物理治疗师(54% [SD = 6%] vs 41% [SD = 6%])。健康记录(忠实性)指标的平均得分从基线时的 35% (SD = 12%)上升到随访时的 47%(SD = 15%)。专攻老年医学的物理治疗师的平均得分更高。采用水平和专业化(是/否)并不能解释有效性的差异。理疗师认为有针对性的教育和同行评估会议是重要的促进因素,而为额外的时间投入提供足够的补偿则被认为是必要的。实践中不同的工作流程被认为是一个障碍:结论:物理治疗师对 Coach2Move 干预方法的采用和忠诚度有所提高,但仍有改进的余地。对该方法及其实施的态度是积极的。未来的实施工作可以通过关注第三方支付方和保险公司的公平补偿结构以及优化实践中的组织和财务环境来改进采用情况:本研究评估了 Coach2Move 的实施情况,这是一种临床推理方法,旨在增加老年人的体育锻炼并提高其自我效能。总体而言,研究表明 Coach2Move 有潜力被理疗师有效采用。然而,解决治疗师补偿问题和适应实践工作流程是成功大规模实施的重要考虑因素。
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Implementing the Effective Coach2Move Approach for Community-Dwelling Older Adults With Mobility Limitations in Physical Therapist Practice: A Multi-Methods Process Evaluation.

Objective: The aims of this study were to evaluate the adoption of and fidelity to the Coach2Move approach; identify differences between physical therapists with a specialization in geriatrics and physical therapists without a specialization; explore if level of adoption and specialization explain variances in effectiveness; and explore group differences in attitudes and experiences with implementation.

Methods: A multi-methods process evaluation of Coach2Move implementation through 2 education days, 3 peer-assessment meetings, and an adapted electronic health record was performed alongside a cluster randomized stepped-wedge trial comparing regular care physical therapy with Coach2Move. Participants were 36 physical therapists with a specialization (n = 17) and without a specialization (n = 19) who treated 292 community-dwelling older adults. Level of adoption and fidelity were analyzed by comparing preimplementation scores with scores 1 year later. Coach2Move adoption was measured by e-assessment scores, and fidelity through health record indicators. The impact of specialization and adoption on health outcomes was examined using a mixed-model analysis of variance. Therapists' attitudes and experiences were collected through a survey based on semistructured interviews.

Results: Mean (SD) total indicator scores on the e-assessment (adoption of a Coach2Move mindset) increased from baseline 17% (5%) to 47% (9%) at follow-up. Physical therapists with a specialization in geriatrics scored (mean [SD]) higher than physical therapists without (54% [6%] vs 41% [6%]). Mean (SD) indicator scores on health records (fidelity) increased from 35% (12%) at baseline to 47% (15%) at follow-up. Mean scores of physical therapists with a specialization in geriatrics were higher. Level of adoption and specialization (yes/no) did not explain the variance in effectiveness. Physical therapists identified important facilitators, including tailored education and peer-assessment meetings, whereas adequate reimbursement for the extra time investment was considered a necessity. Different workflows in practices were perceived as a barrier.

Conclusion: Implementation led to increased adoption and fidelity of the Coach2Move intervention by physical therapists but shows room for improvement. Attitudes toward the approach and its implementation were positive. Future implementation efforts on adoption could be improved by focusing on a fair compensation structure by third-party payers and insurance companies and optimizing organizational and financial context within practices.

Impact: This study evaluated the implementation of Coach2Move, a clinical reasoning approach designed to increase physical activity and improve self-efficacy in older adults. Overall, the study demonstrates the potential of Coach2Move to be effectively adopted by physical therapists. However, addressing therapist compensation and adapting to practice workflows are important considerations for successful large-scale implementation.

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来源期刊
Physical Therapy
Physical Therapy Multiple-
CiteScore
7.10
自引率
0.00%
发文量
187
审稿时长
4-8 weeks
期刊介绍: Physical Therapy (PTJ) engages and inspires an international readership on topics related to physical therapy. As the leading international journal for research in physical therapy and related fields, PTJ publishes innovative and highly relevant content for both clinicians and scientists and uses a variety of interactive approaches to communicate that content, with the expressed purpose of improving patient care. PTJ"s circulation in 2008 is more than 72,000. Its 2007 impact factor was 2.152. The mean time from submission to first decision is 58 days. Time from acceptance to publication online is less than or equal to 3 months and from acceptance to publication in print is less than or equal to 5 months.
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