Mixed-Methods Approach to Understanding Determinants of Practice Change in Skilled Nursing Facility Rehabilitation: Adapting to and Sustaining Value With Postacute Reform.
Allison M Gustavson, Cherie V LeDoux, Julie A Stutzbach and 3 others
PMID 33534337WHAT IT FOUND
Therapists who sustained high-intensity resistance training worked in patient-centered systems with cohesive teams.
Those who failed were hindered by reimbursement pressures, poor team communication, and ageist assumptions that older adults could not tolerate intense exercise.
Key findings
01Reimbursement models that prioritize patient needs over billing constraints fostered sustained practice change.
02Discordant team dynamics and reliance on temporary staff hindered implementation, whereas cohesive teams that trained all members sustained the intervention.
03Therapists who overcame preconceived notions about older adults' ability to tolerate high-intensity exercise successfully changed their practice.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only two SNF sites were studied, limiting generalizability. Only half of the therapists at SNF-L participated in the focus groups, so their perspectives on barriers may be incomplete. Differences in facility size, team size, and training modes between the two sites may have influenced the results.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that high-intensity resistance training is ineffective based on the poor implementation at SNF-L. The study shows that practice change failed due to system and team barriers, not because the intervention itself does not work.