Factors Associated With Physical Therapists' Implementation of Physical Activity Interventions in the Netherlands

Huijg, Johanna M.; Dusseldorp, Elise; Gebhardt, Winifred A.; Verheijden, Marieke W.; Zouwe, N. van der; Middelkoop, Barend J C; Duijzer, Geerke; Crone, Mathilde R.

doi:10.2522/ptj.20130457

Cited by 22 publications

(13 citation statements)

References 62 publications

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“…This echoes previous findings by Huijg et al , who showed that physiotherapist skill level was one of the most important predictors of fidelity. 21 A more targeted approach to enhancing fidelity in future interventions may therefore be warranted, such as identifying physiotherapists at higher risk of lower fidelity using post-training evaluation scores and employing more focused fidelity assessment of delivery or further training for these providers, 13 as has been previously employed in similar interventions. 10 43 The results of the study also showed that physiotherapists with more experience of certain aspects tended to emphasise these at the expense of delivering other components as comprehensively as intended in the protocol.…”

Section: Discussionmentioning

confidence: 99%

“…This aspect considers strategies that enhance the fidelity of delivery (eg, using treatment manuals or intervention protocols) and methods that assess this delivery (eg, provider self-report, audio or video-recorded observations and direct in vivo observations). However, although previous research has advocated a combination of these strategies in order to assess fidelity in-depth, 21 22 limited examples exist within the literature. Additionally, few studies have explored the relationship between these methods, and the accuracy of potentially more feasible methods against the ‘gold standard’ of direct observations using prespecified criteria 23 has been poorly investigated.…”

Section: Introductionmentioning

confidence: 99%

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Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain

2017

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Objectives and designDespite an increasing awareness of the importance of fidelity of delivery within complex behaviour change interventions, it is often poorly assessed. This mixed methods study aimed to establish the fidelity of delivery of a complex self-management intervention and explore the reasons for these findings using a convergent/triangulation design.SettingFeasibility trial of the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) intervention (ISRCTN49875385), delivered in primary care physiotherapy.Methods and outcomes60 SOLAS sessions were delivered across seven sites by nine physiotherapists. Fidelity of delivery of prespecified intervention components was evaluated using (1) audio-recordings (n=60), direct observations (n=24) and self-report checklists (n=60) and (2) individual interviews with physiotherapists (n=9). Quantitatively, fidelity scores were calculated using percentage means and SD of components delivered. Associations between fidelity scores and physiotherapist variables were analysed using Spearman’s correlations. Interviews were analysed using thematic analysis to explore potential reasons for fidelity scores. Integration of quantitative and qualitative data occurred at an interpretation level using triangulation.ResultsQuantitatively, fidelity scores were high for all assessment methods; with self-report (92.7%) consistently higher than direct observations (82.7%) or audio-recordings (81.7%). There was significant variation between physiotherapists’ individual scores (69.8% - 100%). Both qualitative and quantitative data (from physiotherapist variables) found that physiotherapists’ knowledge (Spearman’s association at p=0.003) and previous experience (p=0.008) were factors that influenced their fidelity. The qualitative data also postulated participant-level (eg, individual needs) and programme-level factors (eg, resources) as additional elements that influenced fidelity.ConclusionThe intervention was delivered with high fidelity. This study contributes to the limited evidence regarding fidelity assessment methods within complex behaviour change interventions. The findings suggest a combination of quantitative methods is suitable for the assessment of fidelity of delivery. A mixed methods approach provided a more insightful understanding of fidelity and its influencing factors.Trial registration numberISRCTN49875385; Pre-results.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain

2017

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“…Completeness and fidelity have been used in earlier studies to explain the success of implementation, as well as evaluation tool for conceptual model to support increasing PA in children [ 20 ]. Based on a conceptual framework by Carroll et al (2007) completeness is defined as quantity or perfection of dose, i.e., how fully the intervention components are met or whether all the people who should be participating in actually do so [ 21 , 22 ]. Fidelity is defined as quality of the intervention components, i.e., how well the intervention components are met or whether all the people implement the content of program [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

The effects of mothers’ musical background on sedentary behavior, physical activity, and exercise adherence in their 5-6-years-old children using movement-to-music video program

et al. 2018

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ObjectivesThe purpose of this study was to examine whether mothers’ musical background has an effect on their own and their children’s sedentary behavior (SB) and physical activity (PA). The aim was also to assess children’s and their mothers’ exercise adherence when using movement-to-music video program.DesignSub-group analysis of an intervention group in a randomized controlled trial (ISRCTN33885819).MethodSeventy-one mother-child-pairs were divided into two categories based on mothers’ musical background. Each pair performed 8 weeks exercise intervention using movement-to-music video program. SB and PA were assessed objectively by accelerometer, and exercise activity, fidelity, and enjoyment were assessed via exercise diaries and questionnaires. Logistic regression model was used to analyze associations in the main outcomes between the groups.ResultsThose children whose mothers had musical background (MB) had greater probability to increase their light PA during the intervention, but not moderate-to-vigorous PA compared to those children whose mothers did not have musical background (NMB). SB increased in both groups. Mothers in the NMB group had greater probability to increase their light and moderate-to-vigorous PA and decrease their SB than mothers in the MB group. However, exercise adherence decreased considerably in all groups. Completeness, fidelity, and enjoyment were higher among the NMB group compared to the MB group.ConclusionsThe present results showed that mothers without musical background were more interested in movement-to-music exercises, as well as their children. For further studies it would be important to evaluate an effect of children’s own music-based activities on their SB and PA.

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“…Emotional attachment to longstanding beliefs about best practice may be a barrier to adoption despite compelling evidence for an intervention. 28 More…”

Section: Discussionmentioning

confidence: 99%

Biomarker implementation: Evaluation of the decision‐making impact of CXCL10 testing in a pediatric cohort

Lamarche

Sharma

Goldberg

et al. 2020

Pediatric Transplantation

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Background: Children are at high risk for subclinical rejection, and kidney biopsy is currently used for surveillance. Our objective was to test how novel rejection biomarkers such as urinary CXCL10 may influence clinical decision-making to indicate need for a biopsy. Methods:A minimum dataset for standard decision-making to indicate a biopsy was established by an expert panel and used to design clinical vignettes for use in a survey. Pediatric nephrologists were recruited to review the vignettes and A) estimate rejection risk and B) decide whether to biopsy; first without and then with urinary CXCL10/Cr level. Accuracy of biopsy decisions was then tested against the biopsy results. IRA was assessed by Fleiss Kappa (κ) for binary choice and ICC for probabilities.Results: Eleven pediatric nephrologists reviewed 15 vignettes each. ICC of probability assessment for rejection improved from poor (0.28, P < .01) to fair (0.48, P < .01) with addition of CXCL10/Cr data. It did not, however, improve the IRA for decision to biopsy (K = 0.48 and K = 0.43, for the comparison). Change in clinician estimated probability of rejection with additional CXCL10/Cr data was correlated with CXCL10/ Cr level (r 2 = 0.7756, P < .0001). Decision accuracy went from 8/15 (53.3%) cases to 11/15 (73.3%) with CXCL10/Cr, although improvement did not achieve statistical significance. Using CXCL10/Cr alone would have been accurate in 12/15 cases (80%). Conclusion:There is high variability in decision-making on biopsy indication. Urinary CXCL10/Cr improves probability estimates for risk of rejection. Training may be needed to assist nephrologists in better integrate biomarker information into clinical decision-making.

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Factors Associated With Physical Therapists' Implementation of Physical Activity Interventions in the Netherlands

Abstract: This study enhances the understanding of how physical therapists implement PA interventions and which factors influence their behaviors. Knowledge about these factors may assist in the development of strategies to improve physical therapists' implementation behaviors.

Cited by 22 publications

References 62 publications

Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain

Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain

The effects of mothers’ musical background on sedentary behavior, physical activity, and exercise adherence in their 5-6-years-old children using movement-to-music video program

Biomarker implementation: Evaluation of the decision‐making impact of CXCL10 testing in a pediatric cohort

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