Management of musculoskeletal conditions with remotely delivered physiotherapy versus face-to-face physiotherapy: process evaluation of the REFORM trial using the Realist Evaluation and the RE-AIM Framework

Abstract

Objectives The objectives of this process evaluation were to explain the results of the REFORM (REhabilitation FOR Musculoskeletal conditions) trial and identify potential facilitators and barriers to the future rollout of a remotely delivered physiotherapy model of care. Setting Outpatient physiotherapy units in five government-funded public hospitals in Sydney, Australia. Design This process evaluation was run alongside the REFORM trial. The REFORM trial (n=210) set out to determine whether remotely delivered physiotherapy (with one initial face-to-face session with a physiotherapist) was as good or better than a course of face-to-face physiotherapy. The process evaluation was informed by The UK Medical Research Council Process Evaluation Guidance. It was also based on the Realist Evaluation and the dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework. Qualitative and quantitative data were collected. The qualitative data included semistructured interviews. The quantitative data included audits of screening logs and participants’ self-reported satisfaction with service delivery. A thematic analysis using both inductive and deductive approaches was used for qualitative analysis. Multiple data were used to triangulate the process evaluation findings. Participants Quantitative data were collected on 210 participants. Qualitative interviews were conducted with 20 participants, 15 physiotherapists and 5 stakeholders. Results Some participants valued the convenience and accessibility of remotely delivered physiotherapy. It was also deemed to have the potential of improving the efficiency in the way physiotherapy is delivered. The findings from the RE-AIM framework were mixed. For example, the Reach was limited, and the Adoption and Maintenance were inconsistent across sites.