The abstract reports the findings from the REFORM process evaluation. Our aims were to (i) explain the trial results and the generalisability of the REFORM model of care, and (ii) to identify barriers and facilitators to the future roll out of the remotely delivered physiotherapy intervention.
This process evaluation used mixed methods analysing both qualitative and quantitative data from many different sources. We followed the recommendations of the UK Medical Research Council’s guidelines for process evaluations of complex interventions. We examined each causal assumption using two frameworks namely, the Realist Evaluation and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework.
Most of our program theories from the Realist Evaluation were supported by various data sources. Supported program theories were increased convenience and accessibility for patients. However, the program theory of participant empowerment was less convincing. Results from the 5 dimensions of the RE-AIM Framework highlighted the barriers and facilitators to the future rollout of the intervention. For example, results related to the Maintenance dimension of the RE-AIM Framework showed that this model of care had support from different stakeholders. Various data sources also showed that the trial intervention was implemented (Implementation dimension) as intended and reasonably well embraced by the sites involved in the trial (Adoption dimension). However, the results from the Reach dimension indicated that our results may have limited generalisability. The median (IQR) age of participants was 53 (41 to 66) and most had chronic conditions. This may not be typical of all people who seek physiotherapy for musculoskeletal conditions.
This process evaluation explained why remotely delivered physiotherapy in the REFORM trial proved to be as good as face-to-face physiotherapy. Many patients and therapists expressed support for remotely delivered physiotherapy primarily on the basis of its convenience and ability to empower patients, its potential to reduce waiting times and increase access for all to physiotherapy. Remotely delivered physiotherapy is also more cost effective compared to the usual face-to-face physiotherapy. This was shown by an economic analysis.
This model of remotely delivered physiotherapy has potential to be rolled out into usual clinical practice. Adequate support, access to mobile devices and stable internet as well as training for staff can facilitate the roll out of this model of care. Patients’ and therapists’ attitudes to adoption may be a barrier to implementing this model of care. Therefore, it is important to incorporate patients’ and therapists’ attitudes to adoption and co-design implementation strategies for the future roll out of this model of care.
Musculoskeletal conditions
Process evaluation
