Bridging the Gap After Physical Therapy: Clinical–Community Linkages With Older Adult Physical Activity Programs

Abstract

Background and ObjectivesMany barriers exist to older adult participation in physical activity, despite known benefits. Referrals from physical therapists (PTs) through clinical–community linkages offer novel, promising opportunities to increase older adult engagement in appropriate community-based physical activity programs. We assessed the capacity of PTs to participate in such linkages.Research Design and MethodsWe collected qualitative data using semistructured phone interviews (n = 30) with PTs across 14 states. We conducted thematic analysis using a priori themes based on the 2008 Bridging Model of Etz and colleagues: capacity to assess patient risk, ability to provide brief counseling, capacity and ability to refer, and awareness of community resources.ResultsRisk assessment and counseling were already part of routine practice for our respondents, but counseling could be further facilitated if PTs had more skills to engage less-motivated patients. PTs expressed a desire to refer their patients to community programs; however, barriers to referrals included lack of knowledge of and trust in community programs, and limited infrastructure for communicating with potential partners.Discussion and ImplicationsPTs have the capacity to develop patient referral linkages with community-based physical activity programs. PT session length and content facilitates patient risk assessment and behavioral counseling. Integrating motivational techniques can help PTs engage less-motivated patients in physical activity. Systemic improvements should include innovations in communication infrastructure, identifying clinic-level champions, and in-person outreach initiated by organizations that deliver community physical activity programs.

Provider–Patient Communication and Involvement in Physical Activity Programs Among Patients Receiving Physical Therapy Services: A Qualitative Study

“…The purpose of this study was to describe how providers and their patients interact and communicate about PA and to explore the barriers and facilitators to patient involvement in PA programs. We expand upon the work of Fishleder et al (2018), who used a systems perspective to assess PTs' capacity to partner with community organizations to increase patient referrals to PA programs. Using the same data source, we focus here on provider-patient interactions with their physical therapy care team and on the determinants of PA among patients seeing physical therapy providers.…”

“…In the current study, providers gave patients information about how to perform assigned exercises and existing transportation services. When describing PTs' ability to provide brief behavioral counseling, Fishleder et al (2018) found that PTs helped patients acquire "barrier-breaking" skills to increase PA program participation. The way in which PTs interacted with their patients aligns with the Exercise as a Vital Sign program, which focuses on evaluating and documenting PA behavior during every patient encounter (Grant, Schmittdiel, Neugebauer, Uratsu, & Sternfeld, 2014).…”

“…This study was part of a larger randomized controlled trial (the PT-REFER trial; clinicaltrials.gov registration number NCT03139461). For a more detailed description of the methodology for the current study, refer to Fishleder et al (2018).…”

“…Interviewed PTs worked in outpatient (30%, n = 9), inpatient (13%, n = 4), and home health settings (20%, n = 6); the largest percentage worked in multiple settings (37%, n = 11). For additional demographic characteristics on interviewed PTs, refer to Fishleder et al (2018).…”

“…Using the same qualitative data source as Fishleder et al (2018), we apply an interpersonal perspective to describe how physical therapy providers and their patients interact and communicate about PA. We also seek to extend Fishleder et al's discussion of the patient determinants of PA program participation, which the authors broadly described within the context of PTs' ability to provide counseling, by using patient and provider data to explore the barriers and facilitators to patient involvement in PA programs. Having a better understanding of the communication that occurs about PA and the determinants to participation among patients receiving physical therapy services can help to inform interventions to improve PA among older adults.…”