Physical Activity Promotion: Moving From Talking the Talk to Walking the Walk.

SYNOPSIS: Despite its demonstrated efficacy, physical activity (PA) promotion is not routinely practiced by clinicians. We provide recommendations to improve PA promotion in routine clinical practice by (1) improving clinicians' capacity through enhancing knowledge, skills, and confidence and (2) improving organizations' capacity through building PA promotion pathways. Promoting PA in routine clinical practice is urgently needed to maximize clinicians' impact on the health of society. J Orthop Sports Phys Ther 2022;52(5):236-242. doi:10.2519/jospt.2022.10859.

Identifying Factors That Influence Physical Activity Promotion in Outpatient Physical Therapist Practice Using the Theoretical Domains Framework.

BACKGROUND AND PURPOSE: Physical activity (PA) promotion is not routine practice for physical therapists. Understanding the PA promotion beliefs of physical therapists may offer targets for behavior change interventions to improve PA promotion. The purpose of this study was to explore outpatient US physical therapists' beliefs about PA promotion and determine which Theoretical Domains Framework (TDF) domains can inform implementation efforts. METHODS: We used a descriptive qualitative research design. A TDF-based interview guide was developed to identify beliefs about PA promotion. Twenty-six outpatient US physical therapists (13 regular PA promoters and 13 irregular PA promoters) completed semistructured interviews. Directed content analysis identified specific beliefs by grouping similar belief statements. Specific beliefs were mapped to TDF domains. RESULTS AND DISCUSSION: Five TDF domains were identified as likely relevant to changing physical therapists' PA promotion behaviors. Key beliefs within those domains included conflicting comments about PA guidelines being evidence based, a lack of confidence to promote PA due to perceived deficits in communication skills, and time constraints as key barriers. Beliefs about improving PA promotion included incorporating screening for baseline PA and continuing education targeting confidence and communication. CONCLUSIONS: We identified key beliefs that influence outpatient US physical therapists' PA promotion. These beliefs identify targets for behavior change interventions to improve PA promotion rates among outpatient US physical therapists including incorporating baseline screening for PA and the development of continuing education training programs.

Physical Therapists' Knowledge, Skills, Beliefs, and Organizations Impact Physical Activity Promotion: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to characterize factors that influence physical therapists' physical activity (PA) promotion practices and map these factors to the Theoretical Domains Framework (TDF) to inform future implementation efforts. METHODS: Six databases (MEDLINE, EMBASE, Scopus, CINAHL, PsychInfo, and Web of Science) were searched from inception to March 11, 2021. Studies were included if they reported physical therapists' PA promotion practices and factors influencing these practices. Study quality was assessed with a modified Newcastle-Ottawa Scale and the Critical Appraisal Skills Programme checklist. Studies were excluded if they did not separate physical therapist PA promotion practices and influencing factors from other health professionals. RESULTS: The search yielded 12,835 references and 27 included studies. Twenty studies were included in a meta-analysis of proportions, whereas 15 studies were included in a meta-analysis of correlations. Very-low to moderate-quality evidence suggests that factors at the individual and organizational levels have very small to moderate associations with PA promotion practices. CONCLUSION: Efforts to improve PA promotion by physical therapists should consider incorporating combinations of individual and organizational factors. Limitations to the body of evidence highlight the need for future research. IMPACT: With PA projected to decrease in the general population by an additional 20% by 2050, PA promotion is urgently needed to maximize physical therapists' impact on the health of society. This study identifies factors that may prove useful for guiding the development of strategies to encourage greater engagement in PA promotion by physical therapists.

Physical Activity Promotion Attitudes and Practices Among Outpatient Physical Therapists: Results of a National Survey.

BACKGROUND AND PURPOSE: Physical activity (PA) promotion delivered by physical therapists is effective. However, little is known about how much PA promotion is integrated into outpatient US physical therapist practice. The purpose of this study was to determine the current PA promotion practices and factors that influence those practices among outpatient US physical therapists. METHODS: A sample of outpatient US physical therapists from the Academy of Orthopaedic Physical Therapy and American Physical Therapy Association (APTA) Geriatrics completed an adaptive online survey that included questions related to PA promotion practices and factors that influence those practices. We dichotomized levels of PA promotion as regular and irregular. Multivariable logistic regression was used to determine what factors predicted regular PA promotion. RESULTS AND DISCUSSION: A total of 522 individuals participated and 393 surveys were included in the analyses (75.3%). Most participants (58.5%) irregularly promoted PA and few reported always screening for patients' PA levels (12.7%). The strongest predictor of regularly promoting PA was screening for baseline PA (odds ratio = 5.07, 95% confidence interval = 2.23, 11.57). Physical therapists' own PA levels compared favorably to the US adult population and other health professionals and predicted PA promotion. Other factors related to capability, opportunity, and environment were predictors of PA promotion. Perceived lack of financial support from insurance companies, lack of support from clinical employers, and a perception of competing priorities were barriers to PA promotion. Despite being a public health priority, the majority of physical therapists surveyed infrequently screen for baseline PA and irregularly promote PA. Perceived financial barriers, lack of organizational support, and prioritizing other patient problems hinder PA promotion in the outpatient setting. CONCLUSION: Despite guidance from national and international governing bodies, US outpatient physical therapists do not regularly promote PA to patients and perceive financial constraints and competing priorities as key barriers. Professional and patient stakeholders should be involved in designing pathways to improve PA promotion practices among outpatient US physical therapists.

Introduction of a psychologically informed educational intervention for pre-licensure physical therapists in a classroom setting.

BACKGROUND: There is an increasing need for physical therapists to address psychosocial aspects of musculoskeletal pain. Psychologically informed practice is one way to deliver this type of care through the integration of biopsychosocial interventions into patient management. An important component of psychologically informed practice is patient centered communication. However, there is little research on how to effectively implement patient centered communication into pre-licensure training for physical therapists. METHODS: Thirty Doctor of Physical Therapy (DPT) students took part in an educational intervention that consisted of one 4-h didactic teaching session and three 1-h experiential learning sessions. Prior to the first session, students performed an examination of a standardized patient with chronic low back pain and were assessed on psychologically informed physical therapy (PIPT) adherent behaviors via a rating scale. Students also completed the Pain Attitudes and Beliefs Scale (PABS-PT). After the last experiential session, students evaluated another standardized patient and were reassessed on PIPT adherent behaviors. Students retook the PABS-PT and qualitative data was also collected. RESULTS: After the educational intervention, students had positive changes in their pain attitudes and belief scores indicating a stronger orientation toward a psychosocial approach to patient care (p < 0.05). Additionally, after the intervention, students showed improvements in their adherence to using PIPT behaviors in their simulated patient interactions (p < 0.05). Qualitatively, students reported a high acceptability of the educational intervention with common themes indicating improved confidence with treating and communicating with complex patients. CONCLUSION: Students had attitudes and beliefs shift towards a more psychosocial orientation and demonstrated improved PIPT behaviors in simulated patient interactions after a brief educational intervention. Future research should investigate best practices for implementation of psychologically informed physical therapy for licensed clinicians.

What Traits Are Reflective of Positive Professional Performance in Physical Therapy Program Graduates? A Delphi Study.

BACKGROUND: Physical therapist program level successes have been associated with cognitive and noncognitive predictors. To our knowledge, no studies in physical therapy have explored predictive criteria for positive professional performance (PPP) in one's career beyond an educational program. The two-fold purpose of this study was to analyze what traits were key indicators of PPP beyond one's academic preparation, with secondary goal to determine whether traits related to PPP could be mediated by academic preparation. METHODS: A three-round Delphi survey targeted expert academicians with a specialization in programmatic performance and student success. RESULTS: Twenty-one Delphi respondents completed all survey rounds; identifying and determining consensus on traits associated with PPP. Respondents determined whether the traits could be influenced by programmatic training. The majority of traits identified with PPP were noncognitive and over half were considered modifiable through academic training. Traits such as critical thinking, promoting and engaging in an active learning process, ethical practice, good communication skills, conveying professionalism, and responsibility for one's own actions scored the highest in the survey. DISCUSSION: Findings may serve to benefit curricular designs of academic health professional programs to improve both programmatic and post-academic success.