The aim of this study was to evaluate the effectiveness of a telehealth physiotherapy advisory service on physical activity of older adults and people with disability, while gathering information on implementation determinants and outcomes.
The Professional Referral to Physical Activity, Sport and Exercise (PROPOSE) study was a hybrid type I effectiveness-implementation cluster randomised controlled trial. Participants were adults with physical disability and older adults (50+ years) who were attending outpatient health services and were willing to receive support to be more active. Participants were randomised to receive either the telehealth physiotherapy advisory service or an information booklet. The telehealth service was developed based on behaviour change theory and qualitative research conducted with health professionals and patients. The service included: 1) Telehealth assessment by physiotherapist trained in health coaching; 2) Identification of suitable physical activity opportunities; 3) Development of a tailored physical activity plan and goals; and 4) Health coaching using motivational interviewing (2-6 sessions over 3 months). Outcomes included steps per day (primary outcome, measured using ActiGraph), moderate-vigorous physical activity (MVPA), self-reported physical activity (hours/week, Incidental and Planned Exercise Questionnaire), anxiety and depression (PROMIS subscales). Our intention-to-treat analyses used linear regression adjusting for baseline values with group allocation as the independent variable. We also collected implementation outcomes of dose, acceptability and satisfaction, analysed using descriptive statistics and inductive content analysis.
Thirty-six patients (26 female; mean age 63.9 years) were randomised to intervention (n=18) and control (n=18) groups over 21 months, with recruitment greatly affected by the COVID-19 pandemic. Participants in the intervention group had a higher daily step count compared with the control group at 3 months (between group difference 2402.7 [95% CI 146.6 to 4658.9] steps) and participated in greater planned and total walking activity (mean difference between groups 1.5 [95% CI 0.1 to 2.9] hours and 2.5 [0.1 to 4.9] hours respectively, p0.05, adjusted for baseline values). Intervention participants also reported greater physical functioning (mean difference between groups 1.8 [0.4 to 3.2] points, p0.011, PROMIS scale 4-20 points). There were no differences observed for MVPA, total self-reported activity, anxiety or depression. Walking programs (n = 10) and home programs (n = 7) were the most common activity types implemented (note many programs were closed during COVID-19). Most participants (83%) were satisfied with the program. Participants valued the knowledge, qualifications and interpersonal skills of the physiotherapist and described a range of physical, emotional and social benefits from receiving the service.
This telehealth physiotherapy advisory service is an effective and acceptable service for increasing daily steps among older adults and people with disability.
Delivering telehealth physical activity support by a physiotherapist trained in health coaching is an effective, acceptable and potentially scalable intervention to address barriers to physical activity for vulnerable populations.
Hybrid trial
Behaviour change
