HEALTH PROFESSIONAL REFERRAL TO PHYSICAL ACTIVITY, SPORT AND EXERCISE: PERSPECTIVES FROM PHYSIOTHERAPISTS

K. West^1,2, C. Sherrington¹, L. Hassett^3,1, K. Purcell¹, A. Haynes¹

¹University of Sydney, Institute for Musculoskeletal Health, Sydney, Australia, ²The Children's Hospital at Wesmead, Physiotherapy Department, Sydney, Australia, ³University of Sydney, Sydney School of Health Sciences, Sydney, Australia

Background: There is strong evidence for the physical, mental and social benefits of physical activity for people of all ages and physical abilities. Regular physical activity can be especially beneficial for people aged 50+ and people across the lifespan with physical disabilities since these groups often have difficulties with daily mobility tasks and/or are at risk of deterioration in physical function over time. These two groups also have low levels of physical activity participation.
Regular participation in structured physical activities including exercise, sport and physical recreation can be an enjoyable way to enhance physical activity. Health professionals can have an important role in identifying suitable opportunities and recommending their clients participate in these opportunities. However, health professionals in NSW hospitals rarely make such recommendations. Understanding and addressing the current knowledge and implementation barriers faced by busy health professionals is essential in designing programs to enhance connections between health services and community-based physical activities.

Purpose: The purpose of the study was to explore the current practices of physiotherapists in promotion of physical activity with a focus on referral to community-based structured physical activity opportunities for older clients and people of all ages with physical disabilities and to obtain input from physiotherapists to develop and refine strategies to help physiotherapists improve physical activity promotion and referral.

Methods: We used a mixed methods design. We firstly conducted a cross-sectional survey of physiotherapists working in public hospitals in Sydney, Australia. The second part of the study involved a clinician-led qualitative descriptive design with focus groups and individual interviews. Focus groups and interviews were conducted across eight public hospital sites. Transcripts were analyzed descriptively using inductive and deductive codes to synthesize the data. Developing themes were workshopped with the research team acting as "critical friends".

Results: Survey data was collected from 84 physiotherapists from six hospitals. Half of the physiotherapists promoted physical activity frequently or often. Advice regarding participation in structured sport and exercise was less frequent. Those working with children and who were more experienced were more likely to promote physical activity.
A total of 39 mostly experienced physiotherapists, participated in either an individual interview (n = 3) or a focus group (n = 9). Five main themes were identified: putting principles into practice; working with conflicting priorities; multiple client barriers; connections build confidence; and the battle for information. Despite acknowledging a strong role for physiotherapy in physical activity promotion, there was a disconnect between role perception and current practice affected by clinical and administrative constraints, acute clinical priorities, poor quality information and lack of trust in community providers.

Conclusions: Implementation strategies addressing time and information constraints and building partnership connections between health professionals and community-based physical activity providers are worthy of development and testing.

Implications: Physiotherapists can play an important role in physical activity promotion and referral to community-based opportunities for sport and exercise.
Interventions building connections between health professionals and community-based sport and exercise providers need to be developed and tested.
Implementation strategies are needed to better support physiotherapists working in health settings.

Funding acknowledgements: Sydney Health Partners MRFF RART Award 2019

Keywords:
Physical Activty
Health promotion
community exercise and sport

Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Disability & rehabilitation
Service delivery/emerging roles

Did this work require ethics approval? Yes

Institution: Sydney Local Health District

Committee: Sydney Local Health District Ethics Review Committee (RPAH Zone)

Ethics number: 2019/ETH00604