PT-REFER (Physical Therapists Recommending EnhanceFitness to Expand Reach)
The goal of HPRC’s core research project, PT-REFER, is to develop and test an intervention to increase physical therapist referrals of older adults to EnhanceFitness (EF). EF is an evidence-based physical activity program licensed nationally by Sound Generations (formerly known as Senior Services) and offered at YMCAs and other community venues.
Year 3 Findings
We are now beginning the fourth year of this five-year project. Here are some highlights following the conclusion of the active intervention phase in October 2017:
- Maintenance phase of the trial began November 2016, when YMCAs in the intervention no longer received active technical assistance on toolkit implementation.
- Midcourse evaluation of the intervention began May 2017.
- All 20 enrolled YMCA Associations participated in interviews about their experiences establishing partnerships and conducting outreach.
- Nine (9) physical therapist partners of intervention YMCAs were interviewed about their experience receiving outreach from the YMCA specific to EnhanceFitness.
- Preliminary analysis of EnhanceFitness enrollment data and provider outreach data.
Here are some of the findings from the evaluation:
- YMCAs in the intervention arm reported that the toolkit served as an adaptable and highly useful resource.
- Both the YMCAs in intervention and control group highlighted organizational barriers to increasing EnhanceFitness capacity and conducting outreach.
- Physical therapists are invested in building linkages with the YMCA and greatly value in-person contact for outreach.
- Beginning September 2017, the research team is working to design and implement an “intervention supplement” that will address specific findings from midcourse evaluation and process outcome data to date.
- Data collection for the trial will extend through September 2018.
Notable dissemination efforts of preliminary findings:
- Several manuscripts are under development and focus on:
- Developing the intervention toolkit
- Physical therapy clinic capacity for community-clinical linkages
- Developing and pilot testing a partnership evaluation tool for community organizations
- Research was also presented at several academic conferences including APHA, GSA, Academy Health and Elder Friendly Futures.
Year 2 Findings
In the second year of the project, we synthesized the formative research, developed the intervention, and launched the randomized controlled trial.
Here are some of the highlights of the development process and start of the trial:
- In September 2015, the research team and a partner from YMCA of the USA met to outline the structure and content of the intervention. The team:
- Selected a phased 7-month capacity-building intervention modeled on the Institute for Healthcare Improvement’s Breakthrough Series Promoting organizational change through collaborative learning.
- Developed an intervention toolkit including monthly charts of work, activities, worksheets, and support materials
- In January 2016, the draft toolkit was reviewed and revised by the research team and key partners.
- In February 2016, physical therapist and YMCA partners reviewed the toolkit for feasibility.
- Final preparations were made to launch a randomized trial testing the toolkit:
- The toolkit was finalized after incorporating input from the feasibility review.
- An online data entry system was built to collect intervention process data.
- 20 YMCA associations enrolled in the study were randomized to either the intervention or control.
- All participating YMCAs attended study orientation webinars and a project kick-off call.
- The randomized controlled trial launched on April 1, 2016.
- YMCAs in the intervention arm completed monthly toolkit activities from April through October 2016, and received support via monthly technical assistance calls.
- YMCAs in the control arm conducted business as usual.
- Data collection for the trial will continue through March 2018.
We believe EnhanceFitness participation can be increased through partnerships between physical therapists and YMCAs. Early data about program participation and intervention process is now being analyzed. Stay tuned for future updates as we monitor the data.
Year 1 Findings
In the first year, we conducted formative research through observations of physical therapists (PTs) interacting with patients in clinical settings and interviews with PTs and YMCA staff.
Here are some of the findings that drove the design of the intervention to be tested:
- A physical therapy visit fosters dialogue around appropriate physical activity.
- Both PTs and patients see value in physical activity; written information would be helpful for them.
- PT/patient priorities align with EF goals: to improve function, prevent reinjury, reduce pain, and provide a safe, fun activity that is tailored individually to participants.
- PTs are interested in building partnerships with physical activity programs in the community.
- PTs want detailed knowledge of a program’s foundation and structure, and the people delivering it, in order to recommend it to their patients.
- PTs are interested in seeing a coordinated, safe continuum of care for their patients.
- YMCA staff have an extremely diverse set of resources, experience, partnerships, and personalities.
- YMCA representatives feel additional partnerships would benefit their programs.
- Support in providing outreach and expansion would be welcomed by YMCA staff.