{"id":136,"date":"2021-02-02T22:16:29","date_gmt":"2021-02-02T22:16:29","guid":{"rendered":"https:\/\/depts.washington.edu\/hprc\/?page_id=136"},"modified":"2026-04-03T01:19:29","modified_gmt":"2026-04-03T01:19:29","slug":"pt-refer","status":"publish","type":"page","link":"https:\/\/depts.washington.edu\/hprc\/projects\/pt-refer\/","title":{"rendered":"Physical Therapists Recommending Enhance\u00aeFitness to Expand Reach"},"content":{"rendered":"<p><strong>Project Dates: September 30, 2014 \u2013 September 29, 2019<\/strong><\/p>\n<p>Along with our partners at the&nbsp;<a href=\"https:\/\/www.ymca.net\/\">YMCA of the USA (Y-USA)<\/a> and <a href=\"https:\/\/soundgenerations.org\/\">Sound Generations<\/a>, the University of Washington Health Promotion Research Center (UW HPRC) developed and tested an intervention to increase the outreach capacity of YMCAs to physical therapy clinics about referring older adult patients to&nbsp;<a href=\"\/hprc\/programs-tools\/enhancefitness\/\">Enhance\u00aeFitness<\/a>. Our UW HPRC researchers engaged with 20 YMCAs across the country.<\/p>\n<p>During this study, we heard a clear and consistent call from YMCAs for desired support and tools for outreach. This information helped Y-USA understand that&nbsp;<strong>there is an appetite for the type of in-depth support provided in our toolkit<\/strong>&nbsp;and provided the organization an opportunity to formulate solutions for overcoming reported barriers for outreach.<\/p>\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p><em>\u201cCarving out the time to actually do [outreach] and setting that up as one of your objectives I think is important\u2026 association-wide we just need some leadership around these things and some emphasis on the importance of building these programs and relationships.\u201d <\/em><\/p>\n<p><cite><em>\u2013 YMCA staff member<\/em><\/cite><\/p>\n<\/blockquote>\n<p>Our researchers were also able to bring to light a list of organizational characteristics that can set staff up for more successful outreach to physical therapists.<\/p>\n<ul class=\"wp-block-list\">\n<li>A strategic focus on older adult health and on growing Enhance\u00aeFitness<\/li>\n<li>Perceiving outreach as a way to increase program reach and sustainability<\/li>\n<li>Budget support for outreach<\/li>\n<li>Leveraging existing relationships (e.g., board members) to build new partnerships<\/li>\n<li>Dedicated staff time for outreach and partnership development<\/li>\n<li>Having a secure information-sharing system (e.g., secure fax or Electronic Medical Record connection)<\/li>\n<\/ul>\n<p>Ensuring that the characteristics listed above are in place may improve the capacity of YMCAs to reach out to physical therapy clinics, and ultimately increase the number of older adults who enroll in Enhance\u00aeFitness.<\/p>\n<div id=\"uw-accordion-shortcode\">\n<h3>LEARN MORE<\/h3>\n<div class=\"js-accordion\" data-accordion-prefix-classes=\"uw-accordion-shortcode\">\nRead about the details of this research project and our findings throughout the five-year funding cycle.<\/p>\n<div class=\"js-accordion__panel\" >\n<h2 class=\"js-accordion__header\">Background &amp; Team<\/h2>\n<p>\nThe Health Promotion Research Center&#8217;s mission is to partner with communities to conduct prevention research promoting healthy aging that is incorporated into community practice.<br \/>\nY-USA is the national office of the YMCA. Local YMCA branches offer numerous programs for their communities, including physical activity programs.<br \/>\nEnhance\u00aeFitness, owned and licensed by Sound Generations (formerly known as Senior Services), is an evidence-based group exercise program targeted specifically to older adults at all levels of fitness. Enhance\u00aeFitness classes are offered at YMCAs and other community-based settings across the country.<br \/>\nPhysical Therapy Clinics: Because of the personal connection and high levels of trust between physical therapists and their clients, we seek to collaborate with physical therapists to connect older adults with community-based physical activity programs.<\/p>\n<p><strong>Core Research Team<\/strong><br \/>\nTitles and degrees are listed at the time of the project\u2019s completion.<\/p>\n<ul>\n<li>Miruna Petrescu\u2013Prahova, PhD, Principal Investigator<\/li>\n<li>Marlana Kohn, MPH, Research Scientist and Research Project Manager<\/li>\n<li>Lesley Steinman, MSW, MPH, Research Scientist<\/li>\n<li>Sarah Fishleder, MA, MPH, CPH, Graduate Research Assistant<\/li>\n<\/ul>\n<\/div>\n<div class=\"js-accordion__panel\" >\n<h2 class=\"js-accordion__header\">Phases &amp; Approach<\/h2>\n<p>\n<strong>Phase 1: Gather Information<\/strong> (2014-2015)<br \/>\nLearn how physical therapists exchange information with their patients about ongoing physical activity and community resources through clinical observation and interviews with physical therapists.<br \/>\nLearn how YMCAs engage with health care providers in their community, including physical therapists, through interviews with YMCA staff.<br \/>\n<strong>Phase 2: Design the System<\/strong> (2015)<br \/>\nWork with the YMCA and physical therapy clinics to create a system for engaging physical therapists to recommend Enhance\u00aeFitness at the YMCA to their older adult patients when appropriate.<br \/>\n<strong>Phase 3: Test the System<\/strong> (2016-2018)<br \/>\nIn the final step, we will conduct a randomized controlled trial where one group of YMCAs use the system to engage PTs, and another group of YMCAs conduct business as usual. We will compare the results between groups to determine if the system is effective, feasible, and acceptable to older adults, PTs, and YMCA staff.<\/p>\n<\/div>\n<div class=\"js-accordion__panel\" >\n<h2 class=\"js-accordion__header\">Year 3 Findings<\/h2>\n<p>\nHighlights following the conclusion of the active intervention phase in October 2017:<\/p>\n<ul>\n<li>Maintenance phase of the trial began November 2016, when YMCAs in the intervention no longer received active technical assistance on toolkit implementation.<\/li>\n<li>Midcourse evaluation of the intervention began May 2017.<\/li>\n<ul>\n<li>All 20 enrolled YMCA Associations participated in interviews about their experiences establishing partnerships and conducting outreach.<\/li>\n<li>Nine (9) physical therapist partners of intervention YMCAs were interviewed about their experience receiving outreach from the YMCA specific to Enhance\u00aeFitness.<\/li>\n<li>Preliminary analysis of Enhance\u00aeFitness enrollment data and provider outreach data.<\/li>\n<\/ul>\n<\/ul>\n<p>Here are some of the findings from the evaluation:<\/p>\n<ul>\n<li>YMCAs in the intervention arm reported that the toolkit served as an adaptable and highly useful resource.<\/li>\n<li>Both the YMCAs in intervention and control group highlighted organizational barriers to increasing Enhance\u00aeFitness capacity and conducting outreach.<\/li>\n<li>Physical therapists are invested in building linkages with the YMCA and greatly value in-person contact for outreach.<\/li>\n<\/ul>\n<p>Next steps:<\/p>\n<ul>\n<li>Beginning September 2017, the research team is working to design and implement an \u201cintervention supplement\u201d that will address specific findings from midcourse evaluation and process outcome data to date.<\/li>\n<li>Data collection for the trial will extend through September 2018.<\/li>\n<\/ul>\n<p>Notable dissemination efforts of preliminary findings:<\/p>\n<ul>\n<li>Several manuscripts are under development and focus on:<\/li>\n<ul>\n<li>Developing the intervention toolkit<\/li>\n<li>Physical therapy clinic capacity for community-clinical linkages<\/li>\n<li>Developing and pilot testing a partnership evaluation tool for community organizations<\/li>\n<\/ul>\n<li>Research was also presented at several academic conferences including APHA, GSA, Academy Health and Elder Friendly Futures.<\/li>\n<\/ul>\n<\/div>\n<div class=\"js-accordion__panel\" >\n<h2 class=\"js-accordion__header\">Year 2 Findings<\/h2>\n<p>\nIn the second year of the project, we synthesized the formative research, developed the intervention, and launched the randomized controlled trial.<\/p>\n<p>Highlights of the development process and start of the trial:<\/p>\n<ul>\n<li>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:<\/li>\n<ul>\n<li>Selected a phased 7-month capacity-building intervention modeled on the Institute for Healthcare Improvement\u2019s Breakthrough Series Promoting organizational change through collaborative learning.<\/li>\n<li>Developed an intervention toolkit including monthly charts of work, activities, worksheets, and support materials<\/li>\n<\/ul>\n<li>In January 2016, the draft toolkit was reviewed and revised by the research team and key partners.<\/li>\n<li>In February 2016, physical therapist and YMCA partners reviewed the toolkit for feasibility.<\/li>\n<li>Final preparations were made to launch a randomized trial testing the toolkit:<\/li>\n<ul>\n<li>The toolkit was finalized after incorporating input from the feasibility review.<\/li>\n<li>An online data entry system was built to collect intervention process data.<\/li>\n<li>20 YMCA associations enrolled in the study were randomized to either the intervention or control.<\/li>\n<li>All participating YMCAs attended study orientation webinars and a project kick-off call.<\/li>\n<\/ul>\n<li>The randomized controlled trial launched on April 1, 2016.<\/li>\n<ul>\n<li>YMCAs in the intervention arm completed monthly toolkit activities from April through October 2016, and received support via monthly technical assistance calls.<\/li>\n<li>YMCAs in the control arm conducted business as usual.<\/li>\n<\/ul>\n<li>Data collection for the trial will continue through March 2018.<\/li>\n<ul>\n<\/div>\n<\/p>\n<div class=\"js-accordion__panel\" >\n<h2 class=\"js-accordion__header\">Year 1 Findings<\/h2>\n<p>\nIn 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.<br \/>\nHere are some of the findings that drove the design of the intervention to be tested:<\/p>\n<ul>\n<li>A physical therapy visit fosters dialogue around appropriate physical activity.<\/li>\n<li>Both PTs and patients see value in physical activity; written information would be helpful for them.<\/li>\n<li>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.<\/li>\n<li>PTs are interested in building partnerships with physical activity programs in the community.<\/li>\n<li>PTs want detailed knowledge of a program\u2019s foundation and structure, and the people delivering it, in order to recommend it to their patients.<\/li>\n<li>PTs are interested in seeing a coordinated, safe continuum of care for their patients.<\/li>\n<li>YMCA staff have an extremely diverse set of resources, experience, partnerships, and personalities.<\/li>\n<li>YMCA representatives feel additional partnerships would benefit their programs.<\/li>\n<li>Support in providing outreach and expansion would be welcomed by YMCA staff.<\/li>\n<\/ul>\n<\/div>\n<div class=\"js-accordion__panel\" >\n<h2 class=\"js-accordion__header\">Research Citation<\/h2>\n<p>\n<strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18637982\/\">Healthcare Cost Differences with Participation in a Community-Based Group Physical Activity Benefit for Medicare Managed Care Health Plan Members.<\/a><\/strong> Ronald T. Ackermann, Barbara Williams, Huong Q. Nguyen, Ethan M. Berke, Matthew L. Maciejewski, James P. LoGerfo (July 2008)<\/p>\n<p><strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17192331\/\">Impact of a Managed-Medicare Physical Activity Benefit on Health Care Utilization and Costs in Older Adults With Diabetes.<\/a><\/strong>  Huong Q. Nguyen, Ronald T Ackermann, Ethan M Berke, Allen Cheadle, Barbara Williams, Elizabeth Lin, Matthew L Maciejewski, James P LoGerfo (January 2007)<\/p>\n<p><strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18314570\/\">Implementation and effectiveness of a community-based health promotion program for older adults.<\/a><\/strong> J I Wallace, D M Buchner, L Grothaus, S Leveille, L Tyll, A Z LaCroix, E H Wagner (July 1998)<\/p>\n<p><strong><a href=\"https:\/\/journals.sagepub.com\/doi\/10.1177\/0733464806290934\">The Effects of a Community-Based Exercise Program on Function and Health in Older Adults: The EnhanceFitness Program.<\/a><\/strong> Basia Belza, Anne Shumway-Cook, Elizabeth A. Phelan, Barbara Williams, Susan J. Snyder, James P. LoGerfo (August 2006)<\/p>\n<p><strong><a href=\"https:\/\/drive.google.com\/file\/d\/1tonRk7gJxWFw3p26dTJAnKvCHRIEDx8H\/view?usp=sharing\">Centers for Medicare &amp; Medicaid Services,2013<\/a><\/strong> (PDF)<\/p>\n<p><strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22613940\/\">Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years.<\/a><\/strong> Roberta E Rikli, C Jessie Jones (May 2012)<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/ul>\n<\/ul>\n<div style=\"height:40px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<p><em><sub>This project is also known as PT-REFER.<\/sub><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Project Dates: September 30, 2014 \u2013 September 29, 2019 Along with our partners at the&nbsp;YMCA of the USA (Y-USA) and Sound Generations, the University of Washington Health Promotion Research Center (UW HPRC) developed and tested an intervention to increase the outreach capacity of YMCAs to physical therapy clinics about referring older adult patients to&nbsp;Enhance\u00aeFitness. Our&#8230;<\/p>\n<div><a class=\"more\" href=\"https:\/\/depts.washington.edu\/hprc\/projects\/pt-refer\/\">Read more<\/a><\/div>\n","protected":false},"author":2,"featured_media":2213,"parent":102,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/template-small-hero.php","meta":{"footnotes":""},"class_list":["post-136","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Physical Therapists Recommending Enhance\u00aeFitness to Expand Reach - Health Promotion Research Center<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/depts.washington.edu\/hprc\/projects\/pt-refer\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Physical Therapists Recommending Enhance\u00aeFitness to Expand Reach - Health Promotion Research Center\" \/>\n<meta property=\"og:description\" content=\"Project Dates: September 30, 2014 \u2013 September 29, 2019 Along with our partners at the&nbsp;YMCA of the USA (Y-USA) and Sound Generations, the University of Washington Health Promotion Research Center (UW HPRC) developed and tested an intervention to increase the outreach capacity of YMCAs to physical therapy clinics about referring older adult patients to&nbsp;Enhance\u00aeFitness. 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