Phone interviews lasted 30—45 min, were audio-recorded, and were transcribed verbatim by a professional transcriptionist. We protected participant data confidentiality by not audio-recording any personal information such as full names or addresses and sharing audio files securely through a password-protected website. A random sample of transcripts was coded independently by two members of the research team using ATLAS.
The two researchers then met and identified emergent codes that they incorporated into the codebook. After this process, the interview codebook contained 17 a priori codes and 7 emergent codes.
In the iterative coding process, the researchers first discussed areas of disagreement in the sample of transcripts until reaching consensus Bernard et al. After reaching consistent agreement in the sample of transcripts, remaining transcripts were divided and coded independently. The second phase of analysis was to group the 24 a priori and emergent codes into 12 broader themes, which we then mapped onto one of the four anchors of the Bridging Model.
Although some of the themes could be interpreted as relating to more than one anchor, we assigned them to the most relevant anchor for ease of interpretation. Transferability asks whether the research findings are transferable to other contexts and whether they have any larger import Malterud, Age ranged from 22 years to 50 or older, and years of experience ranged from fewer than 5 to 15 or more.
In the next section, we present the key themes that emerged during our analysis, organized by the four anchors of the Bridging Model. Assessing patient risk refers to quick screening procedures integrated into practice, such as one-click operations on the electronic medical record. By the end of treatment, I have a feel for the patient and what their abilities are going to be. Therapist with 15 or more years of experience, home health setting. Multiple tools are already integrated into practice to understand physical activity-related risk for continued exercise.
Some tools are based on patient self-report e. We use different questionnaires.
We use some tests for balance. We use a functional scale. A lot of those scales tell us where someone might be, and if they may need an extra push to really get themselves going. Therapist with less than 5 years of experience, outpatient setting. Therapist with 5—9 years of experience, inpatient setting. Challenges existed in assessing physical activity-related risk in their sickest patients.
Because it was often difficult to predict patient abilities, PTs did not refer to programs until they obtained a clear understanding of progress. They [the patient] could be very incapacitated when they first come in.
Therapist with 15 or more years of experience, inpatient setting. Behavioral counseling interventions include condensed, tailored discussions mixing assessment, behavior change advice, and counseling. PTs saw encouraging physical activity outside the clinic as a responsibility and their main goal for the patient. PTs reported counseling almost all older adult patients repeatedly throughout the episode of care. Counseling included encouragement, following up, and ensuring the patient had adequate information.
Ideally, I have people make a connection or check out the class before I discharge them, so that I can follow up with them. Is it something that you felt safe while you were doing? At least have you made the call? Do you know where the building is located, so that you can follow up in the future? Several strategies emerged to counsel patients about the benefits of physical activity. Therapist with over 15 years of experience, outpatient setting. Counseling to join physical activity programs included the reduction of instrumental barriers i.
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I do my best to get them connected with community resources to access busing or. Therapist with less than 5 years of experience, home health setting. Therapist with 10—14 years of experience, inpatient setting. Counseling targeted both short-term recovery i. Basically, after we have done the rehab and gotten into a much higher functional level. Therapist with more than 15 years of experience, inpatient setting.
Interviews showed no organized systems in place to refer patients, who often went home with written materials or flyers to follow up by themselves. PTs noted they usually lost track of patients after discharge.
Really, for the most part [. Some PT practices with clinics in multiple states have policies and restrictions on referral processes, such as having to offer multiple programs.
I work for a big organization. Therapist with 5—9 years of experience, outpatient setting. Most PTs also noted the importance of a strong communication infrastructure for any potential linkage. Just kind of helping to bridge that gap. Therapist with 10—14 years of experience, outpatient setting. On the other hand, one therapist suggested that obtaining feedback about a patient after discharge might not be appropriate from a patient privacy perspective.
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There was a clear desire to build close linkages with programs. PTs felt partnerships would enable continued supervision of the patient, encourage adherence, and expand the relationship beyond referrals. Having a relationship with something like that is like bridging the gap from therapy into the community. I mean, it just gives us a place. I develop relationships and most PTs develop relationships with their clients.
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Therapist with more than 15 years of experience, home health setting. The instructors are going to get to know those patients. They might notice a change in medical status. I mean, maybe a person has developed a sudden onset of vertigo, and their balance has just gone downhill. It would be nice to have kind of that back-and-forth communication just because that exercise program might spend more time with the patient and recognize things that need to be addressed.
Awareness of community resources requires that specific community programs be available and that someone in the clinic have a deep enough understanding to navigate the system. Most PTs reported knowing of very few options in the community for older adults and were not aware of specific program details.
I think the main thing is just in my area kind of a general lack of options for referring patients out. I can give them [the patient] the general information and then they have to do the research. If I had more information, then I would be able to be more specific with them. Therapist with 10—14 years of experience, multiple settings. It would be my preference, but that is not always an option. Therapist with 15 or more years of experience, outpatient setting. Respondents generally sought knowledge by themselves about physical activity programs, which was inefficient, burdensome, and frustrating.
I was just trying to put together a list of community exercise options.