Kloek C.1,2,3,4, Bossen D.5, de Vries H.6, de Bakker D.1,2, Veenhof C.3,4, Dekker J.7
1Tilburg University, Tranzo, Tilburg, Netherlands, 2Netherlands Institute for Health Services Research, Utrecht, Netherlands, 3University Medical Center Utrecht, Department of Rehabilitation, Physical Therapy Science & Sports, Utrecht, Netherlands, 4Utrecht University of Applied Sciences, Research Group Innovation of Mobility Care, Utrecht, Netherlands, 5Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, Netherlands, 6Saxion University of Applied Sciences, School of Health, Enschede, Netherlands, 7VU University Medical Center Amsterdam, Department of Rehabilitation Medicine & Department of Psychiatry, EMGO Institute, Amsterdam, Netherlands
Background: Ehealth may contribute to more patient empowerment, convenience and better access to health information. We designed and tested e-Exercise, a 12-week blended intervention consisting of up to 5 face-to-face physical therapy sessions and an online intervention to increase physical activity for patients with knee and hip osteoarthritis (OA). Despite its potential, positive reactions of patients and effectiveness, a majority of physical therapists never used the program into their practice. A better understanding which factors influence physical therapists in whether they use e-Exercise or not is important to achieve effective implementation.
Purpose: Aim of this mixed methods study was to identify factors that promote or hinder physical therapists in the use and non-use of e-Exercise.
Methods: This study used an explanatory sequential mixed methods design in order to clarify quantitative data with qualitative research. The study was embedded in a randomized controlled trial comparing e-Exercise with usual physical therapy in patients with knee and hip OA. For this study, physical therapists usage data was analysed and a questionnaire was distributed to all physical therapists in the intervention group. For the qualitative part, a random sub-sample of the intervention group was invited for a semi-structured interview. Thematic analysis and descriptive statistics were used to analyze the interviews and questionnaires respectively.
Results: Of the 122 physical therapists who were invited to use the e-Exercise intervention, 35 (29%) never activated an account, 33 (27%) registered for an account but did not recruit any OA patient and 54 (44%) physical therapists recruited one or more eligible patients. The analysis of the interviews revealed seven themes which are related to program usage; appropriateness/patients willingness, perceived added value, time, workload, professional autonomy, environmental factors and financial consequences. These themes correspond with findings from the questionnaire. Physical therapists indicate that e-Exercise is a user friendly, privacy safe program that support patients in the performance of home exercises. Although the majority of physical therapists reported that they were intended to implement the program into their practice, only 10 physical therapists used the program after the study period. Half of the responders indicated that they had not enough time to integrate e-Exercise in their daily practice and reported that the program does not contain all elements which are important in the treatment of patients with OA. Participants suggested to extend the number of exercises, to ensure more flexibility and commented that the program is only suitable for a limited number of inactive OA patients.
Conclusion(s): The interviews revealed seven themes which are related to the use of e-Exercise. Overall, therapists were moderately positive about e-Exercise. The experienced lack of time and high workload, lack of flexibility of the program and the small pool of eligible OA patients contributed to low usage rates.
Implications: Before implementation, we need to integrate more flexibility into the program and provide a greater diversity of exercises. Other required facets of successful implementation are the provision of an intervention suitable for multiple patient groups and to ensure a healthy business model for physical therapists.
Funding acknowledgements: The study is funded by ZonMw, Dutch Rheumatoid Arthritis Foundation and the Royal Dutch Society for Physical Therapy.
Topic: Musculoskeletal: lower limb
Ethics approval: The study has been approved by the Medical Ethical Committee of the St. Elisabeth hospital Tilburg (Dutch Trial Register NTR4224).
All authors, affiliations and abstracts have been published as submitted.
