Development of a Coaching Protocol to Enhance Self-efficacy Within Outpatient Physical Therapy.
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ABSTRACT: Objective
To describe the development of the Specific, Measurable, Action-Oriented, Realistic, and Timed (SMART) Coaching Protocol to increase exercise self-efficacy in middle-aged and older adults participating in Live Long Walk Strong (LLWS) Rehabilitation Program. LLWS Rehabilitation Program is an innovative physical therapist (PT) delivered outpatient intervention for middle- and older-aged adults with slow gait speed.Design
Phase II randomized controlled trial (RCT) with masked outcome assessment. We applied the Knowledge to Action Framework to develop and implement the LLWS SMART Coaching Protocol within an RCT for the LLWS Rehabilitation Program. Data will be collected at baseline and post intervention at 2, 8 and 16 weeks.Setting
Outpatient; VA Boston Healthcare System.Participants
Community-dwelling veterans (N=198) (older than 50 years) with slow gait speed (<1.0 m/s).Interventions
Participants will be randomized to the LLWS Rehabilitation Program, an 8-week (10-session) PT-delivered intervention, or wait-list control group. Each study visit will introduce a new SMART Coaching module focused on goal setting, exercise adherence, and addressing internal and external barriers to meeting exercise goals.Main outcome measures
Primary outcome is gait speed and secondary outcome is the Self-Efficacy for Exercise Scale.Conclusions
Incorporating cognitive behavioral tools in physical therapy intervention research is critical for targeting motivational processes needed for exercise behavior change.
SUBMITTER: Bamonti PM
PROVIDER: S-EPMC9214325 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC9272464 | biostudies-literature
Project description:BackgroundEarly childhood educators (ECEs) play a critical role in promoting physical activity (PA) among preschoolers in childcare; thus, PA-related training for ECEs is essential. The Supporting PA in the Childcare Environment (SPACE) intervention incorporated: 1. shorter, more frequent outdoor play sessions; 2. provision of portable play equipment; and, PA training for ECEs. An extension of the SPACE intervention (the SPACE-Extension) incorporated only the shorter, more frequent outdoor play periods component of the original SPACE intervention. The purpose of this study was to explore the individual impact of these interventions on ECEs' PA-related self-efficacy and knowledge.MethodsECEs from the SPACE (n = 83) and SPACE-Extension (n = 31) were administered surveys at all intervention time-points to assess: self-efficacy to engage preschoolers in PA (n = 6 items; scale 0 to 100); self-efficacy to implement the intervention (n = 6 items); and, knowledge of preschooler-specific PA and screen-viewing guidelines (n = 2 items). A linear mixed effects model was used to analyze the impact of each intervention on ECEs' self-efficacy and knowledge and controlled for multiple comparison bias.ResultsThe SPACE intervention significantly impacted ECEs' self-efficacy to engage preschoolers in PA for 180 min/day (main effect), and when outdoor playtime was not an option (interaction effect). Further, the interaction model for ECEs' knowledge of the total PA guideline for preschoolers approached significance when compared to the main effects model. Participants within the SPACE-Extension did not demonstrate any significant changes in self-efficacy or knowledge variables.ConclusionsFindings from this study highlight the benefit of ECE training in PA with regard to fostering their PA-related self-efficacy and knowledge. Future research should explore the impact of PA training for ECEs uniquely in order to determine if this intervention component, alone, can produce meaningful changes in children's PA behaviours at childcare.
| S-EPMC7893737 | biostudies-literature
Project description:OBJECTIVE: To compare patient profiles and health care use for physician-referred and self-referred episodes of outpatient physical therapy (PT). DATA SOURCE: Five years (2003-2007) of private health insurance claims data, from a Midwest insurer, on beneficiaries aged 18-64. STUDY DESIGN: Retrospective analyses of health care use of physician-referred (N = 45,210) and self-referred (N = 17,497) ambulatory PT episodes of care was conducted, adjusting for age, gender, diagnosis, case mix, and year. DATA COLLECTION/EXTRACTION: Physical therapy episodes began with the physical therapist initial evaluation and ended on the last date of service before 60 days of no further visits. Episodes were classified as physician-referred if the patient had a physician claim from a reasonable referral source in the 30 days before the start of PT. PRINCIPAL FINDINGS: The self-referred group was slightly younger, but the two groups were very similar in regard to diagnosis and case mix. Self-referred episodes had fewer PT visits (86 percent of physician-referred) and lower allowable amounts ($0.87 for every $1.00), after covariate adjustment, but did not differ in related health care utilization after PT. CONCLUSIONS: Health care use during PT episodes was lower for those who self-referred, after adjusting for key variables, but did not differ after the PT episode.
| S-EPMC3419881 | biostudies-other
Project description:Aims/introductionAlthough patient self-efficacy is known to affect adherence to therapy, no available tool measures self-efficacy of insulin therapy administration while addressing the entire therapeutic process and management. In light of this, we developed the 'Insulin Therapy Self-efficacy Scale (ITSS).'Materials and methodsDevelopment of the ITSS involved three phases: (i) item generation and creation of a questionnaire draft; (ii) testing and correcting the items through interviews with patients; and (iii) a multicenter, single-arm study to validate the questionnaire.ResultsA factor analysis and Cronbach's α both confirmed good internal consistency in the patients' confidence regarding the following four factors: the insulin injection procedure, insulin titration, glycemic control and ability to cope with hypoglycemia. Reproducibility was confirmed using weighted κ statistics and intraclass correlations. Good concurrent validity was confirmed with two other questionnaires. The ITSS score was also found to correlate with several patient characteristics and clinical parameters, as well as with a better adherence to injected insulin therapy 6 months later, suggesting the predictive validity of this scale.ConclusionsThe ITSS is a reliable and valid tool for assessing and quantifying patients' self-efficacy. The ITSS estimation of self-efficacy can predict a patient's glycemic control and future adherence to insulin therapy. These characteristics will ensure the usefulness of the ITSS in ensuring a successful therapeutic process for patients and physicians.
| S-EPMC6400175 | biostudies-literature
Project description:IntroductionGiven the burden of diabetes in ethnic minorities and emerging data on the efficacy of financial incentives in type 2 diabetes mellitus (T2DM), it is critical to examine the efficacy of financial incentives across and within racial/ethnic groups.Methods and analysisThis trial is an ongoing 5-year, randomised clinical trial designed to test the efficacy of a Financial Incentives And Nurse Coaching to Enhance Diabetes Outcomes (FINANCE-DM) intervention composed of (1) nurse education, (2) home telemonitoring and (3) structured financial incentives; compared with an active control group (nurse education and home telemonitoring alone). The study also will evaluate whether intervention effects are sustained 6 months after the financial incentives are withdrawn (ie, 18 months post-randomisation) and whether the intervention is differentially efficacious across racial/ethnic groups. Participants will include 450 adults with a clinical diagnosis of T2DM and HbA1c of 8% or higher who self-identify as White, African American or Hispanic. Participants will be randomised to one of two groups: the FINANCE intervention or Active Control. The location and setting of this study include primary care clinics at the Medical College of Wisconsin (MCW) in Milwaukee, WI and community partner sites affiliated with the Center for Advancing Population Science at MCW.Ethics and disseminationThis trial was approved by IRB at MCW under PRO00033788.Trial registration numberRegistration for this trial on the United States National Institute of Health Clinical Trials Registry can be found under ID: NCT04203173 and online (https://clinicaltrials.gov/ct2/show/NCT04203173?id=NCT04203173&draw=2&rank=1).
| S-EPMC7757449 | biostudies-literature
Project description:BackgroundPatient engagement in decisions regarding their health care may lead to improved outcomes and improved adherence to treatment plans. While there are several options for involving patients in their health care, goal setting is a readily accessible method for physical therapists to increase the involvement of patients in health care decisions. Physical therapy goals are often generated by health care providers based on subjective information or standardized, fixed-item, patient-reported outcome measures. However, these outcome measures may not fully reveal the activity and participation limitations of individual patients. Goal attainment scaling (GAS) is a patient-centered approach that allows patients to set meaningful goals. While GAS has been shown to be reliable, valid, and sensitive to change in various populations, there is limited evidence in the United States on utilizing GAS in physical therapy for patients with chronic low back pain (LBP).ObjectiveThe purpose of this paper is to describe the protocol for a study to (1) develop a way to apply GAS procedures for physical therapists treating patients with chronic LBP in the United States and (2) test the feasibility of applying GAS procedures for chronic LBP in an outpatient physical therapy setting.MethodsThis study used a mixed methods design with 2 phases: qualitative and quantitative. The qualitative phase of the study employed focus groups of patients with chronic LBP to identify an inventory of goals that were important and measurable. A series of prompts was developed from this inventory to assist physical therapists in collaboratively establishing goals with patients in a clinical setting. The quantitative phase of the study pilot-tested the inventory developed in the qualitative phase in patients with chronic LBP to determine feasibility, reliability, validity, and responsiveness. We also plan to compare how well GAS reveals change over time relative to traditional, fixed-item, patient-reported measures.ResultsPhase 1 data collection was completed in June 2020, while data collection for phase 2 was performed between March 2021 and December 2021. We anticipate that this study will demonstrate that GAS can be implemented successfully by outpatient physical therapists, and that it will demonstrate clinically important changes in patients with chronic LBP.ConclusionsGAS represents an opportunity for patient-centered care in the physical therapy management of chronic LBP. While GAS is not new, it has never been studied in real-world physical therapy for chronic LBP in a clinical setting. Due to unique time and productivity constraints, for GAS to be successfully implemented in this environment, we must demonstrate that clinicians can be trained efficiently and reliably, that GAS can be implemented in a clinical setting in under 15 minutes, and that GAS is able to detect clinically meaningful changes in patient outcomes.International registered report identifier (irrid)DERR1-10.2196/32457.
| S-EPMC8938834 | biostudies-literature
Project description:BACKGROUND:In individuals with neuromuscular diseases (NMD), symptoms of muscle weakness, fatigue and pain may limit physical activity. Inactivity leads to reduced physical fitness, which further complicates daily life functioning. Due to inconclusive evidence regarding exercise in NMD, the optimal training approach and strategies to preserve an active lifestyle remain to be determined. The physical activity programme I'M FINE, consisting of individualized aerobic exercise to improve physical fitness and coaching to preserve an active lifestyle, was therefore developed. The primary objective of this study will be to evaluate the efficacy of the I'M FINE programme in terms of improved physical fitness in individuals with slowly progressive NMD, compared to usual care. METHODS:A multicentre, assessor-blinded, two armed, randomized controlled trial will be conducted in a sample of 90 individuals with slowly progressive NMD. Participants motivated to improve their reduced physical fitness will be randomized (ratio 1:1) to the I'M FINE intervention or usual care. The I'M FINE intervention consists of a six-month physical activity programme, including individualized home-based aerobic exercise to improve physical fitness (i.e. peak oxygen uptake), and motivational interviewing coaching (e.g. goal setting, self-management) to adopt and preserve an active lifestyle. Measurements will be performed at baseline, post-intervention, and at 12- and 18-months follow-up. The primary outcome is peak oxygen uptake (VO2 peak) directly post intervention. Main secondary outcomes are physical capacity, muscle strength, self-efficacy, daily activity, quality of life and markers of metabolic syndrome. The primary analysis compares change in VO2 peak post-intervention between the intervention and usual care group, with analysis of covariance. DISCUSSION:The I'M FINE study will provide evidence regarding the efficacy of a physical activity intervention on the physical fitness and active lifestyle over the short- and long-term in individuals with slowly progressive NMD. These outcomes could potentially improve the (inter)national guidelines for efficacy of aerobic exercise programmes and provide insight in achieving a more active lifestyle in NMD. TRIAL REGISTRATION:(5/11/2018): Netherlands Trial Register NTR7609 (retrospectively registered), https://www.trialregister.nl/trial/7344. However, the Ethics Review Committee of the Amsterdam Medical Center (AMC) approved the study protocol on 7/11/2017. No adjustments were made to the approved study protocol before the first participant enrolment and registration. Registration was done after the second participant enrolment and the information in the register corresponds one on one with the approved study protocol.
| S-EPMC7218829 | biostudies-literature
Project description:It is unclear the role of salient psychosocial variables, such as physical activity (PA) enjoyment and self-efficacy, has on PA within parent-adolescent dyads. The purpose of this study was to examine the interdependent relationships among enjoyment, efficacy, and self-reported PA within parent-adolescent dyads using the Actor-Partner Interdependence Model (APIM). The sample consisted of 1854 parent-adolescent dyads enrolled in the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study. A panel research organization invited panel members balanced to the US population on sex, Census division, household income and size, and race/ethnicity. Panel members were screened for eligibility and web-based surveys were administered to each selected parent-adolescent dyad. Each individual answered questions pertaining to PA enjoyment, PA self-efficacy, and reported weekly PA using validated questionnaires. Interrelationships among the observed variables were analyzed using APIM via a partially recursive path analysis. There was a significant correlation between parent and adolescent PA (r?=?0.15, p?<?0.001). Psychosocial variables explained more variance in adolescent PA (R2?=?0.252) than parent PA (R2?=?0.037) and the strongest standardized path coefficients were adolescent enjoyment (b?=?0.24; 95%CI: 0.18-0.29; p?<?0.001) and self-efficacy (b?=?0.27; 95%CI: 0.22-0.32; p?<?0.001) predicting adolescent PA. Adolescent- and parent-driven effects (0.7%-6.5%) and actor-driven effects (3.3%-5.7%) explained the majority of the systematic dyadic covariance in self-reported PA. There is a relatively strong association between adolescent enjoyment and self-efficacy with adolescent PA and the relationship between parent and adolescent self-reported PA is partially explained by parent and adolescent psychosocial variables and actor-driven effects within APIM.
| S-EPMC6697559 | biostudies-literature
Project description:BackgroundCancer rehabilitation is a developing area, with an increasing number of survivors of cancer in the United States. The increase in survivorship occurs alongside impairments arising directly from cancer or from treatment-related side effects.ObjectiveThis study described clinical characteristics of patients with cancer referred for outpatient physical therapy and explored patterns in frequency of impairments between type of cancer and mode of cancer treatment.DesignThis was a retrospective chart review of patients with cancer referred to a tertiary care physical therapy clinic over a 2-year period.MethodsCharacteristics such as age, sex, cancer type, mode of treatment, and neuromusculoskeletal impairments were identified. Impairment frequencies were computed based on cancer type and mode of treatment.ResultsData from 418 patients (mean age=57.9 years, SD=14.3; 41.1% female) were examined. Genitourinary cancer (n=169) and breast cancer (n=90) were the most prevalent types of cancer reported in this sample. Impairments in strength (83.6%) and soft tissue (71.3%) were the most common examination findings. Lymphedema was most common in patients with breast cancer, and incontinence was most common in patients with genitourinary cancer.LimitationsThe types of cancer identified in this study may be reflective of this tertiary center and may not generalize to other facilities. Impairment identification during the initial physical therapist evaluation was not performed systematically.ConclusionThese data reinforce that physical therapists should screen for lymphedema in patients with breast cancer and incontinence in urogenital cancers. Strength and soft tissue integrity should be evaluated in most patients with cancer. Assessing pain and fatigue levels is recommended for patients who have had radiation therapy.
| S-EPMC4384050 | biostudies-literature
Project description:BACKGROUND:Home-based cardiac rehabilitations (CRs) with digital technologies have been researched and implemented to replace, augment, and complement traditional center-based CR in recent years with considerable success. One problem that technology-enhanced home-based CR can potentially address is the gap between cardiac interventions and formal CR programs. In the Netherlands and some other countries (eg, Australia), patients after cardiac interventions stay at home for 3-4 weeks without much support from their physicians, and often engage in very little physical activity (PA). A home-based exercise program enabled by digital technologies may help patients to better prepare for the later center-based CR programs, potentially increasing the uptake rate of those programs. OBJECTIVE:In a randomized controlled trial (RCT), we will evaluate the effectiveness of a home-based walking exercise program enhanced by self-tracking and mobile-based coaching (treatment condition), comparing it with a version of the same program without these technologies (control condition). The added value of the digital technologies is justified if patients in the treatment group walk more steps on average (primary outcome) and show better physical fitness in a bicycle ergometer test and higher self-efficacy toward PA (secondary outcomes). METHODS:Based on a power analysis, we will recruit 100 cardiac patients and assign them evenly to the 2 parallel groups. Eligible patients are those who are scheduled in the postanesthesia care unit, know the Dutch language, have basic literacy of using smartphones, and are without medical conditions that may increase risks associated with PA. In a face-to-face meeting with a nurse practitioner, all patients are prescribed a 3-week exercise program at home (2 walking exercises per day with increasing duration), based on national and international guidelines and tailored to their physical conditions after cardiac intervention. Their physical activities (daily steps) will be measured by the Axivity AX3 accelerometer worn at hip position. Patients in the treatment group will also be supported by a Neo Health One self-tracking device and a mobile platform called Heart Angel, through which they are monitored and coached by their nurses. After the study, all patients will perform a bicycle ergometer test and return the devices within 1 week. In addition, 5 questionnaires will be sent to the patients by emails to assess their self-efficacy toward PA and other psychological states for exploratory analyses (at discharge, at the end of each monitoring week, and 1 week after the study). To minimize bias, the randomization procedure will be performed after introducing the exercise program, so the nurse practitioners are blind to the experimental conditions until that point. RESULTS:The study protocol has been approved by the Medical Research Ethics Committees United on February 26, 2018 (NL 62142.100.17/R17.51). By the end of 2018, we completed a small pilot study with 8 patients and the results based on interviews and app usage data suggest that a larger clinical trial with the targeted population is feasible. We expect to complete the RCT by the end of 2021, and statistical analyses will follow. CONCLUSIONS:Results of the RCT will help us to test the hypothesized benefits of self-tracking and mobile-based coaching for cardiac patients in home-based exercise programs during the discharge-rehabilitation gap. If the results are positive, cost-effectiveness analysis will be performed based on the insights of the study to inform the translation of the technology-enhanced program to clinical practice. We also note limitations of the trial in the discussion. TRIAL REGISTRATION:Registered at Netherlands Trial Register NL8040; https://www.trialregister.nl/trial/8040. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):PRR1-10.2196/16737.
| S-EPMC7468644 | biostudies-literature