Identifying Potential Determinants That Can Impact the Implementation of a Physical Activity Pathway in Outpatient Physical Therapy: A Mixed Methods Study

Abstract

Importance Most physical therapists do not address older adults' inadequate physical activity (PA), resulting in increased risk of experiencing falls or frailty. Objective The objective was to identify determinants that can impact the implementation of a PA pathway that provides physical therapists with step-by-step guidance on assessing and addressing older adults' inadequate PA levels. Design The design was a convergent parallel mixed-method design. Setting The setting of this study was outpatient physical therapy. Intervention(s) or Exposure(s) The intervention being examined is a PA pathway that provides guidance on assessing and addressing older adults' inadequate PA levels. Main Outcome(s) and Measures(s) The main outcome was determinants that can impact the implementation of the PA pathway. Methods Our quantitative surveys examined current practice, knowledge, and barriers related to assessing and addressing inadequate PA levels, and perceptions about the pathway's feasibility, acceptability, and appropriateness. The semi-structured interviews examined determinants that may impact the decision to use the PA pathway. The study included outpatient physical therapists who treated patients aged 65 years and older, with 51 completing the survey and 16 completing the interview. Results Over 88% perceived the PA pathway as an acceptable, appropriate, and feasible innovation that can guide physical therapists through the recommended PA assessments and behavior change techniques. Barriers identified in the quantitative and qualitative data were lack of knowledge, skills, and confidence in assessing and addressing PA, patient's preference of not doing PA, and lack of time. Two additional barriers identified via the qualitative data were lack of information on how to use behavior change techniques and lack of electronic health record infrastructure. Reimbursement's impact on implementing the PA pathway was mixed. Conclusion and Relevance The gap in assessing or addressing older adults' PA levels could be resolved through the step-by-step guidance provided by the PA pathway. The successful adoption of the pathway can be enhanced via a plan that addresses the potential barriers identified in this study.