Building community-clinical linkages to increase older adult physical activity: The PT-REFER trial protocol and participant baseline characteristics

Abstract

Background Physical activity is important for maintaining older adult health, but a majority of older adults are not meeting recommended physical activity levels. This paper describes the protocol and participant baseline characteristics for a trial (named “PT-REFER”) to test an intervention focused on developing community-clinical linkages to increase older adult referrals from physical therapy clinics to an evidence-based group exercise program (Enhance®Fitness) (EF) offered by YMCA associations. Methods We designed a two-arm cluster-randomized controlled trial with YMCA associations. We conducted formative research with YMCA staff and physical therapists to inform intervention format and content. The primary outcome is the number of new participants enrolled in EF over the course of 30 months. We also collect process information on cost and implementation though structured surveys and semi-structured qualitative interviews. Results The PT-REFER intervention creates a learning collaborative for YMCA associations, which are tasked with implementing a number of capacity- and partnership-building activities over the course of seven months, and participating in monthly group technical assistance calls. We recruited 20 YMCA associations from 13 states. At baseline, the average number of EF sites per association was 3.9 and the monthly average number of new EF participants was 3.7. Conclusions This study will test an approach to increasing the capacity of YMCAs for conducting outreach to physical therapy clinics, and evaluate the factors that may influence its implementation. As a result, it has the potential to contribute to our understanding of how to develop viable and sustainable community-clinical linkages for older adult health.

Development and Feasibility Testing of the Clinical-Community Linkage Self-Assessment Survey for Community Organizations

“…A YMCA Association can consist of a single YMCA site (called branch), or be the umbrella organization for multiple branches in an area. The goal of PT-REFER was to develop and test an intervention facilitating CCLs between YMCA Associations and physical therapy clinics to increase referrals from the clinics to Enhance®Fitness, a physical activity program for older adults available through YMCA Associations (details are available at clinicaltrials.gov/ct2/show/NCT03139461) ( 26 ). The University of Washington Institutional Review Board approved this study.…”

“…Examples include interventions focused on community health workers ( 14 – 16 ) system or clinical level interventions ( 17 – 21 ), pediatricians ( 22 , 23 ), nursing students ( 24 ), and reviews describing screening and connection strategies ( 25 ). Some examples also provide descriptions of specific CCL protocols ( 26 – 28 ).…”

Clinical-community linkages as a strategy for increasing evidence-based program reach: Results of the PT-REFER randomized controlled trial with older adults and YMCA associations

“…We follow CONSORT guidelines for reporting and have provided a checklist in an “additional file” [ 16 ]. A more detailed description of the methods was published separately [ 17 ]. The University of Washington (UW) Institutional Review Board approved all protocols for this study.…”

“…As incentive for participation in the trial, both intervention and control Associations received payments totaling $2500 during the course of the RCT. Additional details about the recruitment and review process are available elsewhere [ 17 ].…”

Models for establishing linkages between healthcare and community: A scoping review

“…Literature is increasingly emerging on interventions to develop linkages for various health conditions, including hypertension (Blyler & Rader, 2019; Joshi et al, 2019), diabetes (Loskutova et al, 2016; Noel et al, 2020), and obesity (Alexander et al, 2021; Messiah et al, 2016). These types of interventions have linked different types of healthcare providers, including physicians (Messiah et al, 2016), physical therapists (Petrescu‐Prahova et al, 2019) and pharmacists (Blyler & Rader, 2019), from settings such as primary care (Messiah et al, 2016), hospitals (Shearer et al, 2019) and private clinics (Petrescu‐Prahova et al, 2019). Community resources involved in these linkages include barbershops (Blyler & Rader, 2019), farmers' markets (Joshi et al, 2019), the governmental department of parks and recreation (Messiah et al, 2016) and recreation centres (Petrescu‐Prahova et al, 2019).…”