Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
Geriatric Education and Research in Aging Sciences Centre, Hamilton, ON, Canada.
Arch Osteoporos. 2018 Jan 25;13(1):7. doi: 10.1007/s11657-018-0419-7.
Recommendations suggest a multicomponent exercise for people with osteoporosis. We identified rehabilitation professionals' barriers and facilitators to implementing exercise recommendations with people with osteoporosis, and used those to make suggestions for targeted knowledge translation interventions. Future work will report on development and evaluation of the interventions informed by our study.
Rehabilitation professionals can help people with osteoporosis to engage in a multicomponent exercise program and perform activities of daily living safely. However, rehabilitation professional face barriers to implementing exercise evidence, especially for specific disease conditions like osteoporosis. We performed a behavioural analysis and identified rehabilitation professionals' barriers to and facilitators of implementing disease-specific physical activity and exercise recommendations (Too Fit to Fracture recommendations), and used the Behaviour Change Wheel to select interventions.
Semi-structured interviews and focus groups were conducted with rehabilitation professionals, including physical therapists, kinesiologists, and occupational therapists, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the Behaviour Change Wheel framework, themes were categorized into capability, opportunity, and motivation, and relevant interventions were identified.
Ninety-four rehabilitation professionals (mean age 40.5 years, 88.3% female) participated. Identified barriers were as follows: capability-lack of training in behaviour change, how to modify recommendations for physical and cognitive impairments; opportunity-lack of resources, time, and team work; motivation-lack of trust between providers, fear in providing interventions that may cause harm. Interventions selected were as follows: education, training, enablement, modelling and persuasion. Policy categories are communication/marketing, guidelines, service provision and environmental/social planning.
Key barriers to implementing the recommendations are rehabilitation professionals' ability to use behaviour change techniques, to modify the recommendations for physical and cognitive limitations and to feel comfortable with delivering challenging but safe interventions for people with osteoporosis, and lacking trust and team work across sectors. Future work will report on development and evaluation of knowledge translation interventions informed by our study.
康复专业人员可以帮助骨质疏松症患者参与多组分运动计划并安全地进行日常生活活动。然而，康复专业人员在实施运动证据方面面临障碍，尤其是对于骨质疏松症等特定疾病情况。我们进行了行为分析，确定了康复专业人员在实施特定于疾病的身体活动和运动建议（“太健康而不会骨折”建议）方面的障碍和促进因素，并使用行为改变车轮选择干预措施。
对康复专业人员（包括物理治疗师、运动生理学家和职业治疗师）进行了半结构化访谈和焦点小组讨论，并逐字记录。两名研究人员对数据进行编码并确定了新出现的主题。使用行为改变车轮框架，将主题分为能力、机会和动机，并确定了相关干预措施。
94 名康复专业人员（平均年龄 40.5 岁，88.3%为女性）参与了研究。确定的障碍如下：能力方面——缺乏行为改变方面的培训，以及如何修改针对身体和认知障碍的建议；机会方面——缺乏资源、时间和团队合作；动机方面——提供者之间缺乏信任，害怕提供可能造成伤害的干预措施。选择的干预措施包括：教育、培训、授权、示范和说服。政策类别包括沟通/营销、指南、服务提供和环境/社会规划。
实施建议的主要障碍是康复专业人员使用行为改变技术的能力、为身体和认知限制修改建议以及为骨质疏松症患者提供具有挑战性但安全的干预措施的舒适度，以及缺乏信任和跨部门的团队合作。未来的工作将报告我们研究中提出的知识转化干预措施的开发和评估。
