Implementation of a Personalized, Cost-Effective Physical Therapy Approach (Coach2Move) for Older Adults: Barriers and Facilitators.
Arjan J W van de Sant, Nienke M de Vries, Thomas J Hoogeboom and 1 others
PMID 28753136WHAT IT FOUND
Coach2Move therapy differed from usual care in how goals were set and feedback given, not in the exercises themselves.
Therapists struggled with dual record keeping and income fears, but found coaching helpful for learning the approach.
Key findings
01Coach2Move and usual care physical therapy differed significantly in process quality, particularly in patient centeredness and self-management focus, though treatment plan content scores were similar.
02Therapists reported that the exercises themselves did not differ much from usual practice, but the shift to ability-focused care and shared goal setting did.
03Major barriers to implementation were the burden of using two electronic medical records and fears of reduced income due to fewer sessions, while coaching was a key facilitator.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Raters were not blinded to the intervention because the record types differed. Fidelity was assessed by record review, which may not reflect actual practice. Only 7 of 10 available therapists were interviewed, potentially biasing the view of motivation. The study relied on self-reported experiences and record scores, not direct observation of therapy sessions.
Declared interests
The study was part of a larger trial funded by non-U.S. government sources. The authors declare no specific conflicts of interest that would bias the process evaluation, though the primary researcher provided coaching to the therapists during the trial.
The easy way to misread this
Do not assume that adopting Coach2Move requires changing your exercise repertoire. The study found that the exercises were similar to usual care; the difference lay in the clinical reasoning, goal setting, and feedback processes.